Wright R A
Community Health Services, Denver Health and Hospitals, CO 80204-4507.
JAMA. 1993 May 19;269(19):2544-7.
The current high-cost health care delivery system, which places greater emphasis on acute hospital care than on community-based primary and preventive care, is no longer viewed by policymakers, politicians, and the American public as the ideal model for organizing and providing health care services. Americans want change; however, politicians are responding with a barrage of disjointed finance and cost-containment proposals that fail to address the organization and provision of health care services. Nevertheless, to adequately address problems of cost, access, and quality, reform proposals will need to consider delivery models that create a balance between medical care and health care, between public health and personal health services, and between curative and preventive care. The community-oriented primary care model and the discipline of community and socially responsive medicine is a process for making a health care system more rational, accountable, appropriate, and socially relevant to the public. Consequently, this model, which is now at a pivotal point in its evolution, may serve as a paradigm for reforming the organization and provision of health care services in America.
当前高成本的医疗保健提供系统更侧重于急性医院护理而非基于社区的初级和预防保健，政策制定者、政治家和美国公众不再将其视为组织和提供医疗保健服务的理想模式。美国人希望变革；然而，政治家们却提出了一连串杂乱无章的财政和成本控制提案，这些提案未能解决医疗保健服务的组织和提供问题。尽管如此，为了充分解决成本、可及性和质量问题，改革提案需要考虑那些能在医疗护理与健康保健之间、公共卫生与个人健康服务之间以及治疗与预防保健之间实现平衡的提供模式。以社区为导向的初级保健模式以及社区和社会响应医学学科是使医疗保健系统更具合理性、可问责性、适宜性且与公众更具社会相关性的一个过程。因此，这个目前正处于发展关键节点的模式，可能会成为美国医疗保健服务组织和提供方式改革的范例。
