A new role for ambulatory care: managing the system

Buffeted for many years by the winds of financial pressures, the American health care system is in severe disarray. The major components of this system are expending resources on maintaining their traditional roles in order to serve a public that cannot afford all of them. These elements, namely the hospital industry, the insurance industry, and physicians, are trying to achieve a measure of profitability in a system that seems to have little profit to yield. Perhaps the time has arrived for a restructuring of the basic system in order to reward quality and efficient management rather than to perpetuate systems becoming increasingly irrelevant.