Service models in community-based health: some findings from a literature review

The findings from a review of the literature on community-based health services in Canada in 1991 indicate that two systems of health care exist side by side: the clinical care of the sick and the supportive care of those seeking to keep well. Organizational models of clinical care have not altered much since the introduction of health insurance. The medical profession has been resistant to changing traditional forms of practice organization from fee-for-service businesses treating individuals in isolation to components of an integrated comprehensive health care system. Traditional public health departments offering supportive and preventive care have been more ready to adapt to change. They are now working closely with provincial continuing-care organizers to provide home care for those who might otherwise need institutional care; however they are not closely linked with the clinical care services. More recently, public health departments have engaged in the health promotion movement to give citizens increased control over the conditions affecting their health. Yet we perceived a conflict between the rhetoric and the reality of their work.