Shepperd J D
J Natl Med Assoc. 1977 Feb;69(2):115-9.
Two model inner city health-care delivery systems are examined in terms of their organizational structure, the role of the consumer within them, their strategies for change, and their ultimate impact and effectiveness. A group practice prepayment plan in Baltimore had consumers on its governing board and, in alliance with a powerful medical institution, successfully organized around political, economic, and social issues. An Office of Economic Opportunity (OEO) grant-supported, neighborhood health center in Washington, D.C. was less effective due to its lack of community representation in the decision-making process. The Baltimore model influenced the federal, state, and local governments, while the Washington, D.C. model had stronger local, than national, effects.
本文考察了两个市中心医疗服务提供系统的组织结构、消费者在其中的角色、变革策略以及最终影响和成效。巴尔的摩的一个团体医疗预付费计划让消费者进入其管理委员会，并与一家有影响力的医疗机构结盟，围绕政治、经济和社会问题成功开展了组织活动。华盛顿特区一个由经济机会办公室（OEO）资助的社区健康中心，由于在决策过程中缺乏社区代表，成效较差。巴尔的摩模式影响了联邦、州和地方政府，而华盛顿特区模式的地方影响力大于全国影响力。
