Structural Reforms in Health-Care Delivery

The nearly three decades since World War II have witnessed unprecedented changes in illness-care transactions. A partial listing of the external manifestations of these new arrangements would include such things as the end of the house call, the reversal of the primary care-to-specialist physician ratio, the disappearance of services in the inner city and the countryside, the transformation of the emergency room into the first choice for primary care by more people, the spectacular rise in overall expenditures, the massive traffic in costly equipment, and the rise of physician addiction to it. (Addiction describes the physicians' increasing inclination to resort to technology for diagnosis and treatment; this reliance rapidly becomes a frank dependence that may indeed be physiological, since withdrawal symptoms appear when the victim is removed from his hardware!)

I believe that this era has been a disaster. The illness-care industry is, of course, inseparable from the overall disarray