We're unable to sign you in at this time. Please try again in a few minutes.
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Article |

Access to Care in Regionalized Health Care Systems-Reply

Kevin Grumbach, MD; Geoffrey M. Anderson, MD, PhD
JAMA. 1996;275(10):759. doi:10.1001/jama.1996.03530340022021.
Text Size: A A A
Published online


In Reply.  —Dr James and colleagues are correct to point out that regionalization of tertiary care services must be considered in the context of an overall system for meeting the health care needs of a population. The Dawson report, the classic British treatise on regionalization published in 1920, advised that "The general availability of medical services can only be effected by new and extended organization, distributed according to the needs of the community."1 The model of organization described in the Dawson report, and subsequently implemented in many national health care systems, called for a broad base of accessible primary care services located in the community and a coordinated process for referring and transporting patients to more centralized secondary and tertiary care facilities.2 We agree that the centralization of cardiac surgery services that was the focus of our study is only one element of a system of regionalized care.


Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?




Also Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
Please click the checkbox indicating that you have read the full article in order to submit your answers.
Your answers have been saved for later.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.


Some tools below are only available to our subscribers or users with an online account.

0 Citations

Sign in

Purchase Options

• Buy this article
• Subscribe to the journal
• Rent this article ?

Related Content

Customize your page view by dragging & repositioning the boxes below.