ABSTRACT
This chapter concentrates on the US reforms. Fundamental reforms of the American health care system are underway to attain both universal access and high quality care at reasonable cost. Continuity of care around a personal primary care doctor, shared medical records, and a team approach to continuous quality improvement, form another cluster of criteria for quality that are largely lacking in the present medical system. Continuity of care is the cornerstone of primary care and cost management. Competition breaks up the only proven way to maximize health and quality while minimizing costs-coordinated, continuous, comprehensive primary care. Primary managed care (PMC) offers an exciting way to coordinate a wide range of services that are now scattered among different agencies and budgets. Primary care should go beyond gatekeeping to being the center of community-based services aimed at improving the health of a defined population. PMC implies a new way of allocating funds that suits the American values of local control.
