The form and financing of medical care in the United States of America

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ANY study of health care systems of the nations of the world can and should begin with reference to the essential element of health care, namely, the relationship between the recipient and the provider of care. This represents a moral, ethical, and legal contract in which the roles of the participants are distinct yet equally important.1 In such a contract the physician not only agrees to accept the person as a patient but also assumes the responsibility to provide the medical service to the best of his ability. In other words, he should not only perform personally in an optimal fashion but also resist a system that would restrict his best efforts. Specifically, he should not accept depersonalization of roles and diffusion of responsibility which negate the elemental clearly stated and defined patient-physician contract. The recipient not only asks for assistance but accepts it, implying his willingness to pay for service either personally or through an agent. The agent may be an organization such as Blue Cross or Blue Shield, an insurance company, or any of the various departments of government.

These then are the criteria by which any health care system can be judged. First, is health service available and is it good? Secondly, since goods and services have a cost of production, has provision been made for their purchase? If not, is there a failure in the patient role or in the physician role? As the delivery systems and the payment mechanisms become more complex and depart from . . .



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