Whiteis D G, Salmon J W
Department of Pharmacy Administration, College of Pharmacy, University of Illinois, Chicago 60612.
Henry Ford Hosp Med J. 1992;40(1-2):16-25.
Increasing pressures on private and public hospitals have necessitated a reassessment of urban health care delivery. Patients left unserved by stressed private hospitals have placed a greater burden on public institutions, which themselves are often old, underfunded, and in danger of closure. As policy analysts consider remedies, primary care in community-based settings has reemerged as an important component of planning. We present results of a comparative analysis of five public health care delivery systems (Boston, Dallas, Denver, Milwaukee, and Seattle), reflecting their economic, political, and cultural dynamics. Although significant differences in the relative centralization of care and reliance on community-based clinics are evident, the five cities discussed have incorporated an increased emphasis on preventive and primary care. The diversity among the systems is highlighted; adaptability is apparently a vital component in designing a public health care system appropriate to the needs of particular communities. Implications for Chicago and other cities are discussed.
私立和公立医院面临的压力不断增加，因此有必要重新评估城市医疗服务的提供情况。不堪重负的私立医院无法服务的患者给公共机构带来了更大的负担，而公共机构本身往往老旧、资金不足且面临关闭的危险。在政策分析师考虑补救措施时，基于社区的基层医疗服务重新成为规划的重要组成部分。我们展示了对五个公共医疗服务体系（波士顿、达拉斯、丹佛、密尔沃基和西雅图）的比较分析结果，反映了它们的经济、政治和文化动态。尽管在医疗服务的相对集中化程度以及对社区诊所的依赖程度上存在显著差异，但所讨论的这五个城市都更加重视预防和基层医疗服务。各体系之间的多样性得到了凸显；适应性显然是设计适合特定社区需求的公共医疗体系的关键要素。文中还讨论了对芝加哥和其他城市的启示。
