Frustration and disquiet with medical care is a major symptom of our present culture. The American public has been deluged with information on what fine, crisis-oriented emergency care and the episode-oriented specialty care modern medicine can provide. The public has also experienced the near impossibility of obtaining a third, and less complex care—continuing, comprehensive personal care. At times, some people we serve have not been able to gain access to any nonemergent care, yet provision of all three types of care is clearly within our abilities.
Difficulty in provision of such care at acceptable cost has produced three major pressures on our system of health care and medical education. These are (1) pressure for major change in the method, control and amount of third-party payments for health care, coupled with mounting ire toward supporting biomedical research and medical education from the patient care dollar; (2) increasing public and political resistance