Abstract
This article closes a strand of contributions concerned innovations in organizational structures which started on the first issue of 2007 of our magazine. The aim of this article is to develope ideas to seize conclusive across the four scenarios analyzed, the evolutionary trends that have proved able of guaranteeing importants returns in effectiveness (resorurces consumption) and efficiency (appropriateness and quality of services rendered). Indeed, beyond the particularities of individual reality describes in previous issues, the common denominator if those is in the organization as a lever adapted to meet tipical problems of the professional form and the limits and weakness of the medical-manager model.