The report also emphasized the need to focus ''not upon individual organs and systems but upon the whole man, who lives in a complex social setting. …" (Millis, 1966, p. 35).

From 1966 to the late 1970s variations and refinements of this concept appeared. In a classic monograph, Alpert and Charney (1973) described the three fundamental characteristics of primary medicine (defined as the personal health system of individuals and families, as distinguished from public health): Its clinicians (1) provide first-contact care (as compared to that based on referral), (2) assume responsibility for the patient over time regardless of the presence or absence of disease, and (3) serve as the "integrationist" (serve a coordinating role). They also believed that it was preferable that all family members be cared for by the same physician.

The First IOM Definition

In 1978, the IOM published a report entitled A Manpower Policy for Primary Health Care: Report of a Study (IOM, 1978). The second chapter, which had been released a year earlier as an interim report, defined the essence of primary care as it should and could be practiced: "accessible, comprehensive, coordinated and continual care delivered by accountable providers of personal health services." That definition has been widely quoted and used. It has also proved useful as a touchstone for guiding the assessment of primary care.

Distinguishing Public And Personal Health Services

Meanwhile, work by McKeown (McKeown and Lowe, 1966) and others led to a better understanding of socioeconomic, environmental, and behavioral factors affecting the health of individuals and populations. In a 1974 report, Canadian Minister of Health Marc Lalonde emphasized the importance of health promotion and disease prevention (Lalonde, 1974). Subsequently, the notion of primary care was expanded to the point where the World Health Organization conference at Alma-Ata defined primary health care as

essential health care … made universally accessible to individuals and families in the community … through their full participation and at a cost that the community and country can afford (WHO, 1978, p. 3).

This definition takes the notion of primary care beyond what this IOM committee intends. The committee therefore distinguishes between two terms: (1) primary health care as defined by WHO, which includes such public health measures as sanitation and ensuring clean water for populations; and (2) this committee's term primary care, which focuses on the delivery of personal health services. For this reason, this report addresses personal health services in a



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