Dr Ellwood is President of The Jackson Hole Group, Teton Village, Wyo, and Dr Lundberg is Editor, JAMA. Dr Ellwood owns stock in Medical Logic, Oxford Health Plan, and Physicians Health Services.
Reprints: Paul M. Ellwood, Jr, MD, The Jackson Hole Group, PO Box 350, Teton Village, WY 83025.
The modern JAMA has been working toward comprehensive American health system reform since 1987, emphasizing cost control, access for all, and promotion of quality.1 One of us (P.M.E.) has been developing market-based health system thinking for more than 25 years.2 The concept of managed care is hardly new. The Kaiser plans began in the American West in the 1930s.3 The massive reform that has occurred in the 1990s has been phenomenal and largely unpredicted, although much of it has been called for by many authors.4-6 Many patients, providers, and purchasers alike consider the system to be in turmoil, some even in chaos. But movement is profound and irreversible, at least in the short run.
As we go forward, we believe that physicians should be more involved and influential in determining where the American health system is going. It is unrealistic to expect to return to unmanaged,
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
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