Dr. David Rutstein, Ridley Watts Professor of Preventive Medicine at Harvard Medical School, unfolds in this book—written for laymen—a systematic plan for building a sound and functional national medical care program, one in which all the components and modular units are joined into a single structure to provide better-quality and more efficient health care.
Although the need for a national medical care program is widely conceded to be urgent, legislation has not been forthcoming for lack of a definitive, detailed program. This book meets just that need. As MIT President Jerome Wiesner writes, “... a major reason for the delay in the enactment of national health legislation is the lack of a specific professional and technical plan of medical delivery to serve as a basis of agreement.
“I believe that Doctor Rutstein's plan could fill this gap. His blueprint proposes a plan for integrating the individual units of a national health program into a complete system. Most important, it makes provision for critical review, testing, and evaluation so that modification and improvement may be effected without delay as experience and research results are accumulated. The plan incorporates a quality control system that can measure the effect of the operation of the separate units of the program on the health of the population.”
This quality control system is a significant innovation: it enables medical professionals to design, reorganize, and operate full health care programs in regional centers throughout the country that should yield better health for Americans. As feedback from these centers is monitored by the National Center for Health Statistics and the Center for Disease Control under a proposed Federal Health Board, needed adjustments of policy can be effected.
But the book contains numerous other highly specific proposals, dealing with such topics as the creation of a system of national and regional health units that are professionally independent of the federal and state bodies that fund them –the institutional structure of the hospital of the future—area wide emergency medical care—improved ambulatory care—a new method of payment to physicians and new methods of medical care financing—a solution to the medical manpower muddle—needed changes in the curriculum of medical education—and new developments in information processing and medical communications, including consultation at a distance.
For all the reliance on computer use and the application of systems theory that the book supports, Dr. Rutstein has by no means lost sight of the personal, human relationships that are an important part of patient care. In urging that the number of medical generalists be increased, he writes that “The heart of the proposed medical care system is a personal physician relationship to offer guidance, reassurance, and support to the patient.... As this blueprint unfolds, it will become clear that it is proposed to increase the number of general physicians, to assign to them the role of 'captain of the team,' and to allocate to them the responsibility for primary, personal, and continuous care for each individual patient.”
