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The increasing fragmentation and rising costs of medical care highlight the need for new approaches, especially the need for alternatives for the delivery of a full range of services at the local level. This book is the first to offer a model for a comprehensive community-based health practice that can compete effectively in the health care market. In their analysis of a health center affiliated with New York Medical College, the authors present systematic profiles of every aspect of operation, together with anecdotal accounts contributed by physicians, nursing staff, patients, and those responsible for third-party payment.
The authors begin with an overview of the organization, its philosophy, and guiding concepts. In separate chapters they describe policies and procedures for each functional area, from patient care and staff functions to facility management and finance. Four chapters are devoted to anecdotal narratives that give a picture of the center's operation from the vantage point of those most closely involved in the delivery of medical services. The final chapter discusses the potential role of local comprehensive practice centers in solving our nation's health care dilemmas and reflects on the policy initiatives that will be required to implement such a solution. This book will be of interest to policy-makers, consumer advocacy groups, and those in the health care field, as well as to scholars and researchers in medical education, the social sciences, and public administration.
List of contents
Preface
Introduction
Overview of the Organization
First Narratives--Being There and Moving Over: Organizational Change
Referral and Routing
Patient Care: Delivery of Services
Patient Care: Staff Organization
Second Narratives--The Children, Hard Cases, and AIDS Cases: Those Needing Care the Most
Education and Training
Personnel Functions
Third Narratives--An Aide's Case, Trainees, and Staffing: Those Who Do the Work
Information System
Facility
Finance and Accountability
Fourth Narratives--Compliance and Fees: Where the Parties Sometimes Conflict
Public Policy
Appendices
Index
About the author
Richard Brotman, David Hutson, Irving Silverman, Frederic Suffet
