“Well, you know we've only been a tertiary care hospital for the last 30 to 40 years; maybe we should consider what we need to be for the future.” There must be a vision of the future in the United States to make health care change easier rather than a reflex “digging in of heels” to resist the loss of something we have had.

Finally, the energy and action orientation of Americans is incredibly unique. Many other countries struggling to make changes in their health care systems know what they want to achieve, but they do not have the managerial or organizational skills or resources required to make those changes. We do, if we have the will and the vision. That is one of our gifts as a people. We must use this gift to begin and sustain a process of change that can ensure the best health care delivery system and the best health for all of our citizens.

REFERENCES

1. U.S. Public Health Service, Surgeon General of the United States. 1979. Healthy People. Washington, DC: U.S. Government Printing Office.

2. Alpert, J., and Charney E. 1973. The Education of Physicians for Primary Care. DHEW Pub. No. (HRA), 74-3113. Washington, DC: U.S. Department of Health, Education, and Welfare.

3. Secretary of State for Health. 1992. The Health of the Nation. London: Her Majesty's Stationery Office.

4. Institute of Medicine. 1978. A Manpower Policy for Primary Health Care. Washington, DC: National Academy of Sciences.

5. Nutting, P. 1987. Community-Oriented Primary Care: From Principles to Practice. Washington, DC: U.S. Department of Health and Human Services.

6. White, K., Williams, T.F., and Greenberg, B.G.. 1961. The ecology of medical care. New England Medical Journal 265:885–892.

7. Silver, G. 1974. Family Medical Care: A Design for Health Maintenance. Cambridge, MA: Ballinger.

8. Rosen, G. 1949. A History of Public Health. New York: MD Publications.

9. The National Primary Care Conference. 1992. The National Primary Care Conference Executive Summary. Washington, DC: U.S. Department of Health and Human Services.

10. Moore, G. 1992. The case of the disappearing generalist. Milbank Quarterly 70(2): 361–379.

11. Stevens, R. 1966. Medical Practice in Modern England. New Haven, CT: Yale University Press.

12. Tully, S. 1992. America's painful doctor shortage. Fortune 16:68–72.

13. Funkenstein, D. 1978. Medical Students, Medical Schools and Society During Five Eras: Factors Affecting Career Choices of Physicians 1958–1976. Cambridge, MA: Ballinger.

14. Bowles, R. 1992. Understanding the pay structure of GPs. Primary Health Care Management 2(12):2–5.

15. Ginsburg, E. 1992. Health care reform—where are we and where should we be going? New England Journal of Medicine 327(18):1310–1312.



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