Community health and managing the care of a population

The new health care marketplace requires a rethinking of the way care is given, including fiscal responsibility, medical accountability, a priority on the needs of society and objective but fluid definitions of standards and quality. These developments are being driven by escalating costs and dwindling competition within the private sector. The health care delivery system is being called to change the present "managed care" to "managing" care, requiring the resurgence of the doctor-patient relationship. This relationship must not neglect its relationship to the community and populations who make up the neighborhoods, cities and our nation. The reality of economic and financial incentives cannot be denied, but the ultimate result of the current transformation of the health care delivery system will be the re-establishing of the core moral and ethical incentives and principles of health care at the front of the decision tree and before economic incentives.