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January 11, 1995, Vol 273, No. 2 >
Health Care Policy: A Clinical Approach | January 11, 1995

The Organization of Health Care

Kevin Grumbach, MD; Thomas Bodenheimer, MD, MPH
[+] Author Affiliations

Edited by Drummond Rennie, MD, Deputy Editor (West).

Corresponding author: Kevin Grumbach, MD, Primary Care Research Center, UCSF Box 1364, San Francisco, CA 94143-1364.


From the Department of Family and Community Medicine (Drs Grumbach and Bodenheimer) and the Institute for Health Policy Studies (Dr Grumbach), University of California, San Francisco.


JAMA. 1995;273(2):160-167. doi:10.1001/jama.1995.03520260082038
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References

Frank Hope has walked with a limp since his attack of polio in the 1940s. When he watches his daughter run after her young toddler, he experiences a sense of gratitude that the era of vaccinations has protected his child and grandchild from such a disabling infection. He recalls the sense of excitement that gripped the nation as the Salk polio vaccine was first tested and then adopted into widespread use. In Frank's mind, these types of scientific breakthroughs attest to the wonders of the US health care system.

Frank's grandson attends a day-care program. Ruby, a 2-year-old girl in his program, was recently hospitalized for a severe case of measles complicated by pneumonia. She spent 2 weeks in a pediatric intensive care unit, including several days on a respirator. She had not received her measles immunization, normally scheduled for 15 months of age. Ruby's mother works full-time as a

REFERENCES

1 +
Centers for Disease Control.  Cases of specified notifiable diseases, United States, weeks ending June 30, 1990, and July 1, 1989 (26th week). MMWR Morb Mortal Wkly Rep . 1990;;39:448.
2 +
General Accounting Office. Preventive Health Care for Children: Experience from Selected Foreign Countries . Washington, DC: General Accounting Office; 1993;. Publication GAO/HRD-93-62.
3 +
Fielding JE, Cumberland WO, Pettitt L.  Immunization status of children of employees in a large corporation. JAMA . 1994;;271:525-530.
4 +
Rodwin VO. The Health Planning Predicament . Berkeley: University of California Press; 1984;.
5 +
Dawson W.  Interim report on the future provision of medical and allied services.  In: Saward EW, ed. The Regionalization of Personal Health Services . New York, NY: Prodist; 1975;.
6 +
Bodenheimer TS.  Regional medical programs: no road to regionalization. Med Care Rev . 1969;;26:1125-1166.
7 +
Grumbach K, Fry J.  Managing primary care in the United States and in the United Kingdom. N Engl J Med . 1993;;328:940-945.
8 +
Fry J.  Primary care.  In: Fry J, ed. Primary Care . London, England: William Heinemann Medical Books Ltd; 1980;.
9 +
Bodenheimer T, Grumbach K. Understanding Health Policy: A Clinical Approach . Norwalk, Conn: Appleton and Lange; 1995;.
10 +
Starr P. The Social Transformation of American Medicine . New York, NY: Basic Books Inc Publishers; 1982;.
11 +
Rivo ML, Satcher D.  Improving access to health care through physician workforce reform: directions for the 21st century. JAMA . 1993;;270:1074-1078.
12 +
Starfield B. Primary Care . New York, NY: Oxford University Press Inc; 1992;.
13 +
Aiken LH, Lewis CE, Craig J, et al.  The contribution of specialists to the delivery of primary care. N Engl J Med . 1979;;300:1363-1370.
14 +
Freymann JO. The American Health Care System: Its Genesis and Trajectory . Melbourne, Fla: Robert E Krieger Publishing Co Inc; 1977;.
15 +
Somers AR.  Who's in charge here? Alice searches for a king in Mediland. N Engl J Med . 1972;;287:849-855.
16 +
Luft HS, Garnick DW, Mark DH, McPhee SJ. Hospital Volume, Physician Volume, and Patient Outcomes: Assessing the Evidence . Ann Arbor, Mich: Health Administration Press; 1990;.
17 +
White KL, Williams F, Greenberg BG.  The ecology of medical care. N Engl J Med . 1961;;265:885-892.
18 +
American Academy of Family Physicians. Facts About: Family Practice . Kansas City, Mo: Nielsen Printing Services; 1991;.
19 +
Kroenke K, Mangelsdorff D.  Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. Am J Med . 1989;;86:262-266.
20 +
Sidel V, Sidel R. A Healthy State . New York, NY: Pantheon Books; 1983;.
21 +
Rivo ML, Saultz JW, Wartman SA, DeWitt TG.  Defining the generalist physician's training. JAMA . 1994;;271:1499-1504.
22 +
Benson P, Gabriel A, Kathz H, Steinwachs D, Hankin J, Starfield B.  Preventive care and overall use of services: are they related? AJDC . 1984;;138:74-78.
23 +
Chamey E, Bynum R, Eldredge D, et al.  How well do patients take oral penicillin? a collaborative study in private practice. Pediatrics . 1967;;40:188-195.
24 +
Shear CL, Gipe BT, Mattheis JK, Levy MR.  Provider continuity and quality of medical care: a retrospective analysis of prenatal and perinatal outcome. Med Care . 1983;;21:1204-1210.
25 +
Wasson JH, Sauvigne AE, Mogielnicki RP, et al.  Continuity of outpatient medical care in elderly men: a randomized trial. JAMA . 1984;;252:2413-2417.
26 +
Shea S, Misra D, Ehrlich MH, Field L, Francis CK.  Predisposing factors for severe, uncontrolled hypertension in an inner-city minority population. N Engl J Med . 1992;;327:776-781.
27 +
Franks P, Nutting PA, Clancy CM.  Health care reform, primary care, and the need for research. JAMA . 1993;;270:1449-1454.
28 +
Menken M.  Generalism and specialism revisited: the case of neurology. Health Aff (Millwood) . 1988;;7( (5) ):115-123.
29 +
Greenfield S, Nelson EC, Zubkoff M, et al.  Variations in resource utilization among medical specialties and systems of care: results from the Medical Outcomes Study. JAMA . 1992;;267:1624-1630.
30 +
Welch WP, Miller ME, Welch G, Fisher ES, Wennberg JE.  Geographic variation in expenditures for physicians' services in the United States. N Engl J Med . 1993;; 328:621-627.
31 +
Franks P, Clancy CM, Nutting PA.  Gatekeeping revisited: protecting patients from overtreatment. N Engl J Med . 1992;;327:424-429.
32 +
Roos N.  Who should do the surgery? tonsillectomy-adenoidectomy in one Canadian province. Inquiry . 1979;;16:73-83.
33 +
Nutting PA, ed. Community Oriented Primary Care: From Principle to Practice . Albuquerque: University of New Mexico Press; 1990;.
34 +
Luce JM, Byyny RL.  The evolution of medical specialism. Perspect Biol Med . 1979;;22:377-389.
35 +
Engel GL.  The need for a new medical model: a challenge for biomedicine. Science . 1977;;196:129-136.
36 +
Gonzalez M. Physician Marketplace Statistics . Chicago, Ill: American Medical Association; 1993;.
37 +
Friedson E. Professional Dominance: The Social Structure of Medicine . New York, NY: Atherton; 1970;.
38 +
Light D, Levine S.  The changing character of the medical profession: a theoretical overview. Milbank Q . 1988;;66:10-32.

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Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature

Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal

1 +
Centers for Disease Control.  Cases of specified notifiable diseases, United States, weeks ending June 30, 1990, and July 1, 1989 (26th week). MMWR Morb Mortal Wkly Rep . 1990;;39:448.
2 +
General Accounting Office. Preventive Health Care for Children: Experience from Selected Foreign Countries . Washington, DC: General Accounting Office; 1993;. Publication GAO/HRD-93-62.
3 +
Fielding JE, Cumberland WO, Pettitt L.  Immunization status of children of employees in a large corporation. JAMA . 1994;;271:525-530.
4 +
Rodwin VO. The Health Planning Predicament . Berkeley: University of California Press; 1984;.
5 +
Dawson W.  Interim report on the future provision of medical and allied services.  In: Saward EW, ed. The Regionalization of Personal Health Services . New York, NY: Prodist; 1975;.
6 +
Bodenheimer TS.  Regional medical programs: no road to regionalization. Med Care Rev . 1969;;26:1125-1166.
7 +
Grumbach K, Fry J.  Managing primary care in the United States and in the United Kingdom. N Engl J Med . 1993;;328:940-945.
8 +
Fry J.  Primary care.  In: Fry J, ed. Primary Care . London, England: William Heinemann Medical Books Ltd; 1980;.
9 +
Bodenheimer T, Grumbach K. Understanding Health Policy: A Clinical Approach . Norwalk, Conn: Appleton and Lange; 1995;.
10 +
Starr P. The Social Transformation of American Medicine . New York, NY: Basic Books Inc Publishers; 1982;.
11 +
Rivo ML, Satcher D.  Improving access to health care through physician workforce reform: directions for the 21st century. JAMA . 1993;;270:1074-1078.
12 +
Starfield B. Primary Care . New York, NY: Oxford University Press Inc; 1992;.
13 +
Aiken LH, Lewis CE, Craig J, et al.  The contribution of specialists to the delivery of primary care. N Engl J Med . 1979;;300:1363-1370.
14 +
Freymann JO. The American Health Care System: Its Genesis and Trajectory . Melbourne, Fla: Robert E Krieger Publishing Co Inc; 1977;.
15 +
Somers AR.  Who's in charge here? Alice searches for a king in Mediland. N Engl J Med . 1972;;287:849-855.
16 +
Luft HS, Garnick DW, Mark DH, McPhee SJ. Hospital Volume, Physician Volume, and Patient Outcomes: Assessing the Evidence . Ann Arbor, Mich: Health Administration Press; 1990;.
17 +
White KL, Williams F, Greenberg BG.  The ecology of medical care. N Engl J Med . 1961;;265:885-892.
18 +
American Academy of Family Physicians. Facts About: Family Practice . Kansas City, Mo: Nielsen Printing Services; 1991;.
19 +
Kroenke K, Mangelsdorff D.  Common symptoms in ambulatory care: incidence, evaluation, therapy, and outcome. Am J Med . 1989;;86:262-266.
20 +
Sidel V, Sidel R. A Healthy State . New York, NY: Pantheon Books; 1983;.
21 +
Rivo ML, Saultz JW, Wartman SA, DeWitt TG.  Defining the generalist physician's training. JAMA . 1994;;271:1499-1504.
22 +
Benson P, Gabriel A, Kathz H, Steinwachs D, Hankin J, Starfield B.  Preventive care and overall use of services: are they related? AJDC . 1984;;138:74-78.
23 +
Chamey E, Bynum R, Eldredge D, et al.  How well do patients take oral penicillin? a collaborative study in private practice. Pediatrics . 1967;;40:188-195.
24 +
Shear CL, Gipe BT, Mattheis JK, Levy MR.  Provider continuity and quality of medical care: a retrospective analysis of prenatal and perinatal outcome. Med Care . 1983;;21:1204-1210.
25 +
Wasson JH, Sauvigne AE, Mogielnicki RP, et al.  Continuity of outpatient medical care in elderly men: a randomized trial. JAMA . 1984;;252:2413-2417.
26 +
Shea S, Misra D, Ehrlich MH, Field L, Francis CK.  Predisposing factors for severe, uncontrolled hypertension in an inner-city minority population. N Engl J Med . 1992;;327:776-781.
27 +
Franks P, Nutting PA, Clancy CM.  Health care reform, primary care, and the need for research. JAMA . 1993;;270:1449-1454.
28 +
Menken M.  Generalism and specialism revisited: the case of neurology. Health Aff (Millwood) . 1988;;7( (5) ):115-123.
29 +
Greenfield S, Nelson EC, Zubkoff M, et al.  Variations in resource utilization among medical specialties and systems of care: results from the Medical Outcomes Study. JAMA . 1992;;267:1624-1630.
30 +
Welch WP, Miller ME, Welch G, Fisher ES, Wennberg JE.  Geographic variation in expenditures for physicians' services in the United States. N Engl J Med . 1993;; 328:621-627.
31 +
Franks P, Clancy CM, Nutting PA.  Gatekeeping revisited: protecting patients from overtreatment. N Engl J Med . 1992;;327:424-429.
32 +
Roos N.  Who should do the surgery? tonsillectomy-adenoidectomy in one Canadian province. Inquiry . 1979;;16:73-83.
33 +
Nutting PA, ed. Community Oriented Primary Care: From Principle to Practice . Albuquerque: University of New Mexico Press; 1990;.
34 +
Luce JM, Byyny RL.  The evolution of medical specialism. Perspect Biol Med . 1979;;22:377-389.
35 +
Engel GL.  The need for a new medical model: a challenge for biomedicine. Science . 1977;;196:129-136.
36 +
Gonzalez M. Physician Marketplace Statistics . Chicago, Ill: American Medical Association; 1993;.
37 +
Friedson E. Professional Dominance: The Social Structure of Medicine . New York, NY: Atherton; 1970;.
38 +
Light D, Levine S.  The changing character of the medical profession: a theoretical overview. Milbank Q . 1988;;66:10-32.

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