ABSTRACT
Group practice health maintenance organizations are a uniquely American institution. America is beginning a national debate about health care reform and whether people should have a national health insurance policy. The political momentum to develop a national health insurance policy comes from the large number of middle income Americans who are worried about losing health benefits coverage. Politicians and health care leaders are fond of saying that America has the best health care in the world. Although it may be true that America has the very best practitioners in each category of health care services, it does not mean that it has a high quality health care delivery system. The elements of health care de livery—physicians, hospitals, home care, support functions, and insurance—are integrated into a coherent whole, making it possible for the system to have a significant impact on costs and quality.
