Health Care: Pressure for Change

Report Outline
New Era in Health Care
Responses to High Costs
Cost Containment's Impact
Long-Term Reform Issues
Special Focus

New Era in Health Care

Innovative Service Changing Profession

The family doctor, carrying his black bag on house calls and caring for everything from mother's delivery to junior's measles, has long been a thing of the past. The tools of his trade grew so in size and complexity after World War II that house calls became all but out of the question. No matter how ill, most patients must get to a doctor's office, clinic or hospital for diagnosis and treatment. Once there, the patient is likely to be treated by doctors he has never met. The trusted, if somewhat paternalistic, family physician has been replaced by a myriad of specialists whose interests appear confined to individual organ systems and methods of treatment.

But recent trends indicate changes in America's health care system. The family doctor may be on his way back. The steady concentration of medical and surgical services in large hospital centers is slowing. Free-standing, or independent, clinics are springing up in shopping malls and other unlikely places as private practitioners compete aggressively for patients. By offering prompt attention to a wide variety of ailments at all hours and at relatively low cost, these walk-in “emergicenters” or “surgicenters” provide an attractive alternative to the hospital emergency room or Monday-through-Friday-only doctor's office. Called “docs-in-the-box” by their detractors, emergicenter physicians are accused of conducting their profession as they might a fast-food franchise.

When hospitalization is necessary, inpatient stays are becoming shorter and shorter. A woman whose mother might well have spent a full week in the hospital at her birth can expect to stay only one to three days for a normal delivery today. Many relatively simple surgical procedures, such as tonsillectomies, are conducted on an “in-and-out” basis. Pre-operative preparation, surgery and postoperative care are all completed within hours, with no overnight stay.