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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.
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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.

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