CHARLES E. LEWIS, M.D.; CHARLOTTE NEUMANN, M.D.; LESTER BRESLOW, M.D.
Certain factors related to problems in the delivery of health care are discussed, followed by a description of a new prepayment program providing health care for children of students at UCLA and a discussion of the relationship of the university to the community surrounding it. An analogy is made between the several steps in the process of providing care and a series of biochemical reactions. Problems of gaining entry into the system (becoming a patient), use of screening tests, follow-up of abnormal results, establishment of a definitive diagnosis, and prescription of treatment are all reviewed. The last step in the cycle is patient compliance with the recommendations or prescribed treatment. It is pointed out that the system "processes" the problems of individuals and that the output or end results are changes in the patient's health status. It is impossible to alter any one of the elements of the "system"—manpower, financing methods, organization of care, and expectations of patients—without producing an effect on each of the other elements. Specific examples are given of studies indicating the workings of each of the subsystems, such as patient compliance. The prepayment plan for pediatric care for dependents of students and other efforts in the community are presented as examples of activities that have impact on all parts of the system.
LEWIS CE, NEUMANN C, BRESLOW L. The Health Care System—Maligned or Malignant?. Ann Intern Med. ;74:746–757. doi: 10.7326/0003-4819-74-5-746
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Published: Ann Intern Med. 1971;74(5):746-757.
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Print ISSN: 0003-4819 | Online ISSN: 1539-3704
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