Academic journal article Frontiers of Health Services Management

The Integration of Public Health and Medicine

Academic journal article Frontiers of Health Services Management

The Integration of Public Health and Medicine

Article excerpt

President Clinton's American Health Security Act proposes to reform and integrate the medical care and public health service delivery systems. Historically, there have been examples of efforts to integrate public health and medical activities. Yet, while many have acknowledged the inherent value of such an integrated approach to improving health, the fact is that these efforts have had only limited success. The "new deal" President Clinton has proposed for these health institutions is examined in this context. If the notion of integration is taken seriously--that is to mean the extent to which each system's diverse activities complement each other, fitting together to form an integrated whole--then it will not be easy to achieve. Review of the "visions" of public health and medicine and of examples of efforts to integrate public health and medicine in this country suggest five conditions that must be met if successful integration is to be achieved. While the resources necessary to integrate public health and medicine are great, of equal importance is the acceptance of a shared vision of an integrated health care system, and of the respective roles and responsibilities of public health and medical care in that system. The benefits to our nation's health of proceeding in this way, however, are enormous. As we move into the twenty-first century, an integrated system of public health and medical care services is our nation's best hope for not only improving the health of all our citizens, but for closing the "health gap" between socioeconomically disadvantaged groups and the rest of the population.

President Clinton's American Health Security Act proposes major reforms in the ways in which medicine and public health carry out their missions. For medicine, the Act describes these basic elements of reform:

The American Health Security Act guarantees comprehensive health coverage for all Americans regardless of health or employment status. Health coverage continues without interruption if Americans lose or change jobs, move from one area to another, or become ill or confront a family crisis....Through a system of regional and corporate health alliances that organize the buying power of consumers and employers, the American Health Security Act stimulates market forces so that health plans and providers compete on the basis of quality, service, and price....Under the Act health plans must meet national standards on benefits, quality, and access to care, but each state may tailor the new system to local needs and conditions. Thus the program encourages local innovation within a national framework....It frees the health care system of much of the accumulated burden of unnecessary regulation and paperwork, allowing doctors, nurses, hospitals, and other health providers to focus on providing high-quality care. (The White House Domestic Policy Council 1993, emphasis added)

For the nation's public health system, the president's plan calls for these reforms:

While health reform strengthens the personal care delivery system, an enhanced public health system also plays an essential role to:

* Protect Americans against preventable, communicable diseases, exposure to toxic environmental pollutants, harmful products, and poor quality health care.

* Identify and control outbreaks of infectious disease and patterns of chronic disease and injury.

* Inform and educate consumers and health care providers about the appropriate use of medical services.

* Define and validate new prevention and control interventions....The public health initiative builds on the capability of health alliances and plans to reach out to their participants, providing them with information about prevention and appropriate use of medical services....Because dealing effectively with public health problems requires the coordinated involvement of multiple parties, the initiative is designed to foster inter-agency collaboration and public-private partnerships, including close working relationships between public health, community groups, alliances, and plans. …

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