A New Approach to Medicine Principles and Priorities in Health Care

Medicine is news. There is constant public interest in health and disease; in medical miracles and in breakthroughs; in medical disasters, failures and malpraxis ; in deficiencies and defects ofhealth services; and in the rising costs ofhealth care. Medicine is 'big business'. Physicians co me out near the top money earners in most medical care systems. In the Uni ted Kingdom the National Health Service (NHS) now costs over [6000 million a year ($ ro 800 million), a free service that costs every British man, woman and child [120 a year ($216) in direct and indirect taxes. But this is less than the [500 ($900) a year that medical care costs each person in USA and West Germany. In developed countries health care costs are approaching ro% ofthe gross national product (GNP). It is big business also in that in Britain the NHS is one of the largest employers; about I million Britons work as employees of the NHS, caring for the other 54 millions and in the USA the numbers are 5 million caring for 2. 5 millions. The provision of health services is full of problems and dilemmas. These problems and dilemmas cross all' national boundaries. All countries share the same problems and dilemmas. Problems of objectives, of standards, of effectiveness and efficiency, and problems of relations between the medical profession, the public and govern­ ment. Medical care still is full of mystique.

1 Health care and its problems.- 2 Primary care: a special field.- 3 What is primary care? Content and implications.- 4 Who comes and why? Self-care and primary care.- 5 Work: quantity and quality-manpower policies.- 6 The nature and natural history of common diseases.- 7 Cure and care.- 8 Prescribing.- 9 The hospital-primary care interface.- 10 Community social services.- 11 The primary care team.- 12 Premises and organization.- 13 Prevention and postponement.- 14 Education and learning.- 15 How much care? Present state and future needs.