Part I GOALS AND PROGRAMS As a nation we must provide better quality, more convenient health care for all the people, at reasonable cost, and in a manner in keeping with human dignity. This must be done because we accept one basic, irreducible principle: Health care is an inherent right of each individual and of all the people of the United States. (1) it is a function of health care to enhance the dignity of the individual and to promote better community life for all; (2) it is a function of government to assure the preservation and maintenance of the health of all the people; (3) each individual shares the responsibility for protecting his own health and for obtaining health care when required; (4) health care must be available without regard to any person's ability to pay and without regard to race, creed, color, sex, or age; (5) health services must be so organized and located that they are readily accessible to all. This basic principle and its corollaries can be best and most rapidly implemented through a new nationwide system for the delivery of health services, uniting all the health resources of the United States for better care. The following specific goals are endorsed: 1. A system for the delivery of health services must be developed which has as a primary objective the optimum health care of each and every person. Untreated illness in the community must be sought out and treated. 2. The system for the delivery of health services must focus on individual needs, must be personalized through the skills and 1 humanity of health personnel, and must preserve the dignity of the individual. 3. The system for the delivery of health services must assure that no person becomes financially dependent or suffers loss of dignity as a result of illness or accident. 4. The system must assure that all children are provided with preventive health care and that no child suffers from untreated illness. 5. The system for the delivery of health services must provide comprehensive health care. It must be able to provide the following components of care to each individual as needed: health maintenance, primary care, specialty care, restorative care, and health-related custodial care. Comprehensive health care must be developed as rapidly as possible. 6. The system must be oriented to the maintenance of personal good health and to the prevention of illness rather than being primarily oriented to the treatment of illness after it becomes acute. The system must include financial incentives for keeping people well and, if they are ill, for making them well as soon as possible. 7. The system must include financial incentives for encouraging utilization of ambulatory facilities, extended care and nursing home facilities, and home care programs, rather than reliance predominantly on hospitalization. 8. The system must support only those providers that meet standards of effectiveness, quality, and efficiency. Providers rendering good quality care in the most economic manner must be continued and developed, providers not providing such care must be assisted to do so; and providers unwilling or incapable of providing such care must not be supported. Measurements of the quality of care should be incorporated in the system. 9. The system must, in order to maximize the potential of health resources, encourage innovation and preserve the benefits of alternative choice through a multiplicity of health care providers with varied types of ownership and organizational forms. The predominant concern and mission of all health care institutions and providers must be the public interest regardless of ownership. 10. The system must be designed so that from the outset it provides care for persons suffering from alcoholism, drug abuse, and acute mental illness. The system must also be designed so that long-term mental health care, nonhealth-related custodial care, and institutional care provided by all federal, state, and local governmental hospital systems will be integrated into the total system within a reasonable time. Programs to resolve sociological and environmental problems that affect the health of individuals must be coordinated and integrated with the system for the delivery of health care. The failure to resolve acute sociological and environmental problems adds to the cost and amount of necessary health care of individuals. It must be realized that the pace at which these problems are addressed and solved affects directly the organizational burdens and total effectiveness of the health care system. To accomplish the goals, the existing system for the delivery of health services must be substantially restructured, including both the methods of delivering and financing health services. Priority should be given to the accomplishment of these goals, and the hard choices made of where scarce fiscal, organizational, and manpower resources should be allocated. Attainment of the goal of comprehensive care for all people will require significant expansion of the system's resources. Part II THE HEALTH CARE The Health Care Corporation would synthesize management, physicians, personnel, and facilities into a corporate structure with the capacity and responsibility to deliver comprehensive health care to the community, either directly through its own facilities and services or by contract with other health care providers. Health Care Corporations would have specific responsibility for quality and effective delivery of care by all of its providers— including those with whom it would contract-physicians, dentists, other health professionals, and health care institutions. A sufficient number of Health Care Corporations would be established to make available comprehensive health services to meet the needs of every geographic area and of all of the population, spanning geographic and political boundaries where necessary to assure that all persons have access to at least one Health Care Corporation. Each Health Care Corporation would have a primary geographic assignment established by the State Health Commission. Several such Corporations might have the same geographic assignment and therefore coexist in a city or area and serve population groups beyond political boundaries. The coexistence of Health Care Corporations in one geographic area would depend upon their capacities to coordinate needed services effectively. The Health Care Corporation would be a new corporate organization. It could be established in a variety of ways, depending upon community need, resources, and precedent. Its sponsorship could be local, or it might be broadly based. A Health Care Corporation would be a private or governmental not-for-profit corporation organized to furnish services (through its own resources or through affiliation with other providers, not-forprofit or for-profit) to registrants, and to engage in education, research, and other activities related to the furnishing of personal health services. Many types of organizations could participate with health care providers in the formation of a Health Care Corporation, including health-oriented educational and social organizations, governmental and private organizations, and organizations of health professionals, such as groups of physicians. A Health Care Corporation also could be a consortium, representing a cross section of provider organizations in the community. However organized, the governing boards of Health Care Corporations should include representation of community, consumer registrants, provider administration, and physicians. In addition to consumer registrant and community representation through the governing boards, each Corporation should guarantee meaningful opportunities for all its registrants to express their reactions to the quality, cost, convenience, and accessibility of services. The Health Care Corporation would be a provider of health services, with its primary responsibility the provision of health services for its registrants through programs to assure the public: a) good quality health care monitored through peer and utilization review; b) accessibility, continuity and availability of preventive, emergency, ambulatory, restorative, inpatient, home care, and health education in a continuum so as to economically provide opportunities for prevention of illness, the maintenance of health, and the most appropriate level of care as needed; and, c) fiscal responsibility and accountability and full cooperation with areawide planning. Within its geographic area the Health Care Corporation would have to demonstrate its potential to provide care for all who would voluntarily register during regular periods of open registration and agree to maintain their registration for a fixed period. It would be the responsibility of the Health Care Corporation to encourage the registration of nonregistered individuals including those assigned by the State Health Commission to the Corporation for recruitment. After a reasonable period, the Corporation, within its capacity to provide comprehensive health services, would be |