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OCR for page 283
Workshop A DeWitt C. Baldwin, Jr. The initial impact of the two clinical case presentations made tO our group was to bring about a somewhat discouraging awareness on the part of the workshop participants that neither bore a close resemblance to the clear, rather idealized model presented by Kark and Abramson. After some mo- ments of self-critical discussion, the group came tO the position that there probably is no single or best model of COPC and that each nation or system has to create its own version, based on its unique history and politics, as well as its needs and resources. Therefore, COPC should be considered a flexible concept, especially under the highly competitive conditions of the pluralistic system currently operative in the United States. In thinking of how best to approach promotion and enhancement of the concept of COPC, a number of suggestions were forthcoming. First, it was felt that what is needed is to look for the essential ingredients within current efforts and to creatively enhance and expand them. Second, it was clear that a better determination and dissemination of data on the effectiveness of COPC are needed. The group indicated that such data exist, or are close to the surface, but that they need to be uncovered, assembled, and dissem- inated in order to convince decision makers and funding sources of the effectiveness of COPC. Third, there was an expressed need to exhort medical schools to produce more community oriented graduates through a variety of strategies involving changes in selection, curriculum design, and administrative policies. This was perceived both in terms of increasing the general level of awareness and knowledge about community oriented prac- tice among future practitioners and in terms of increasing the critical mass of student advocates who can serve as a potent political force in the system. 283
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284 PART III: WORKSHOP DISCUSSION SUMMARIES A fourth suggestion was to encourage state and local health departments to place greater emphasis on their data-gathering and dissemination func- tions, which can be of direct assistance to COPC practitioners. Fifth, there was general recognition of the need to shift the general focus or perception of health planning agencies from a negative, regulatory stance toward a more positive information-gathering and dissemination function that can serve to educate decision makers. Finally, advocates of COPC need to enter more effectively into the decision-making arena-and become politically more sophisticated. The group felt there was a need to seek new alliances, to work more closely with (and hopefully to influence) financing sources and mechanisms—insurance sys- tems, prepaid contracts, Medicaid, Medicare to get them to provide greater incentives for community oriented models of practice. Potentially affected constituencies—the poor, the aging, children's groups, minorities, as well as providers, and the decision makers need to be informed of the value of COPC. They are likely the best advocates of change in this area. Ulti- mately, COPC will succeed only if the community supports it and the consumer wants (will buy) it. In conclusion, arising out of what might have but did not become a wake over the current political and economic climate, the group arrived at an upbeat, proactive stance. To quote one member, "The worst of times is the best of times for those who are ready and willing to act."
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