The purpose of this paper is to describe what would, one hopes, be an effective health-care delivery system for the United States in the year 2005. In order for this paper not to be too utopian, some explicit assumptions will also be made about what political developments might happen, or would need to happen, in order for such a system to come into existence.
In order not to reinvent the wheel, the discussion here will be based largely on the excellent and detailed scenario laid out by Hiatt (1987, pp. 190-208) in Chapter 12, ôHealth Services Research: Health 2000, an Experiment in Health Care Delivery,ö of his AmericaÆs Health in the Balance: Choice or Chance? Other health-care professionals who have dealt with this issue will be cited here as well, but Dr. Hiatt has provided the most coherent and logical of such proposals so far seen.
HiattÆs proposal was based not on sheer speculation, but on data collected and evaluated by a stellar planning committee centered around the Harvard School of Public Health. What the committee proposed was that a new health-care delivery system could begin as a regional pilot project, and then be gradually extended to other regions. They were able to see, from the experiences of existing health organizations, that the type of structure they were proposing depended on having the correct size of population base.
The type of integrated health-care delivery system they were contemplating had to be based in a region with a population of about half a million or more, in order for there to be sufficient resources of sufficient diversity to provide the infrastructure needed for the new system. On the other hand, a single regional system could not handle the complete population of the largest metropolitan areas, such as New York or Los Angeles. These would have to be divided up into several regions each, probably with a population base of about two million on average.
Overall, the comm...