Anne R. Somers

The Nation's Health: Issues for the Future

Nine major issues with respect to the nations health are identified: 1) the lifestyle of the consumer and prob lems of health education, 2) availability of 24-hour compre hensive care, 3) rationalization of the delivery system, 4) re- definition of professional roles to assure personalized care, 5) free choice, consumer responsibility, and administrative decen tralization, 6) quality controls, 7) cost controls, 8) long-range financing, and 9) long-term care, especially of the aged.

Consumer health education: a new-old challenge to allied health education.

Abstract The challenge to health education, implicit in the current re-thinking of the basic assumptions underlying U.S. health policy for the past quarter-century, is enormous and unprecedented in the history of the profession. This is true regardless of the fate of any particular bureau or piece of legislation. The challenge involves not only professional health educators but the far larger group of physicians, nurses, behavioral scientists, nutritionists and others involved in one or another aspect of this broad inter-disciplinary field. New manpower studies are urgently needed to identify quantitative and qualitative changes necessary to meet these challenges.

Social, Economic, and Health Aspects of Mandatory Retirement

The issue of mandatory retirement could grow into one of the major domestic conflicts of the next few decades. It cannot be divorced from the availability and adequacy of pensions. Major arguments advanced in favor of mandatory retirement include: easier personnel management, advantages to younger and minority workers, economy for employers, greater productivity, and, in certain industries, greater public safety. Major arguments against include: adverse effect on physical and mental health of many employees, inordinate cost to society--both in terms of pensions and loss of productive labor--and the general positive value of individual performance evaluation. In the effort to resolve the conflict, three principles are suggested as a basis for future policy: (1) the individual benefits more from activity--physical and mental--than inactivity; (2) society benefits more from the maximum feasible productive employment of the adult population; (3) management requires adequate flexibility in the deployment of personnel, and a balance between youth and maturity and the values associated with each age group. Based on these principles, eight specific recommendations are suggested.

Who's in charge here?—or Alice searches for a king in Mediland

There is no king in Mediland. Despite Alices yearning—and she speaks for millions who seek simple solutions to complex problems—there probably never will be, as long as we remain a democracy. What is needed is a shared, multi-group, responsibility within a framework of clearly, but democratically, defined public accountability. Five groups share major responsibility, for both our current problems and their solution: consumers, doctors, hospitals, private health-insurance carriers, and the government. Within this shared responsibility, the pre-eminent role will probably go to the group demonstrating greatest capacity for leadership, which, paradoxically, may mean greatest capacity for self-discipline. The extent to which this self-discipline and leadership are realized may determine whether we achieve a creative new synthesis for medical education, health-care delivery and financing, or whether we doom ourselves to a mutually destructive stalemate.

Health Services in the United States: Groping Toward a “System”?

There is no U.S. “health services system”, in the formal sense of the term, and very little formal coordination between the many fragments, public or private, of this huge and vital industry, which now accounts for nearly 10 percent of the Gross National Product (GNP) and is estimated to cost about

The hospital and the health care delivery system: A case for the franchised hospital

275 billion in 1982.1/ In some important respects, there is even less coordination today — under the antigovernment, pro-competition policies advanced by the Reagan Administration — than there was five years ago. However, this does not mean that the multitudinous programs, agencies, instititions, and individual practitioners are totally lacking in cooperative arrangements, coordination, or other “meaningful relationships”. On the contrary, there is widespread, albeit inconsistent, evidence of increasing coordination, consolidation, and even mergers between and among various institutions and programs.

The high cost of health care for the elderly: diagnosis, prognosis, and some suggestions for therapy.

Abstract Although more federal money is being spent than ever before, there is a continued crisis in the health of the American people. Money alone will not solve the problem, and the emphasis of the last several years on national health insurance has resolved into a legislative stalemate. Rationalization of the delivery system of health care is needed. The most realistic means to accomplish it would be to extend the responsibilities and regulatory functions of the hospitals which are presently the most comprehensive of our health institutions. This could be done through a franchise system involving both state and federal participation.