Primary Care as Part of US Health Services Reform

RECENT history reflects a myriad of problems with the US health service system. In the 1960s, physician manpower shortages received the most attention from policymakers. When efforts to increase the number of physicians succeeded, maldistribution was recognized as a problem. In the 1970s, rapid increases in costs attracted attention and led to the development of several regulatory mechanisms, including the diagnosis related groups, to reduce expenditures associated with hospitalization. In the 1980s, observations of variations in physician practice patterns without concomitant variations in outcomes of care led to a realization that much of medical care lacked benefit, and the movement toward quality control and total quality improvement assumed prominence. In the 1990s, compromised access resulting from the absence of universal health insurance and excessive costs consequent to unnecessary care share the stage in the policy drama. See also p 3156. The poor development of primary care within the US health