Organizing Medical Care Programs to Meet Health Needs

Medical care in the United States is organized around a large number of agencies both governmental and non- governmental, with insufficient co-ordination among them and no effective machinery for over-all planning. There are short ages and maldistribution of both personnel and facilities. The rise in specialization has resulted in continued decline in the number and status of the family physician. Organized group practice, which may offer one possible answer to the fragmenta tion and depersonalization of medical care, has increased, but not to the extent of making a significant impact on the prevail ing solo, fee-for-service pattern of medical practice. Hospitals face especially acute problems in the form of rapidly increasing costs and shortages of staff. Facilities for the care of the chronically ill and aged are insufficient in number and the care they offer is often far from adequate. Some trends that may presage a more rational organization of medical services are the concentration of community medical resources in and around voluntary hospitals; the differentiation of care within hospitals to fit patient needs more closely; the development of hospital-based services for ambulatory and homebound pa tients ; and increasing consideration to the establishment of closer relationships among hospitals, nursing homes, and other facilities serving a given region.