Health Policy and the HMO

Policy making is fraught with difficulty. The long-range results are often far afield from the original expectation. This, of course, has been conspicuous in such fields as defense, foreign affairs and economics. Serious attempts to formulate a national policy for the delivery of medical services are relatively new for the United States. Foreseeing the ultimate result of any policy decision is quite difficult. It was certainly not perceived that the laudable Flexner reform of medical education, aided and implemented by the support of medical education through research funds from the federal government, would ultimately create a crisis in the access to primary medical care. The reforming of medical education to change and shorten the medical curriculum, the creation of a specialty of primary family practice and the genesis of new health professionals, such as the nurse practitioner and the physician's assistant, are all attempts to ameliorate the effects of a policy decision made sixty years ago. This is not to say that the policy decision was wrong; the inference is that the ultimate results were difficult to foresee.