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April 21, 1993

Improving Access to Primary Care-Reply

Author Affiliations

Columbia University New York, NY

JAMA. 1993;269(15):1944. doi:10.1001/jama.1993.03500150051026

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In Reply.  —Dr Alper raises important issues about the relationships between primary care physicians and managed-care organizations that will have substantial influence on patients' choice and treatment modalities. His warning that patients under managed-care arrangements may change carriers frequently is a fear that warrants attention and evaluation. He implies that the present lowly state of primary care medicine is likely to worsen before it improves. Frankly, I don't have as much faith in health economists as does Dr Alper.Dr Gibb's communication is a useful reminder that the Washington-Alaska-Montana-Idaho program in the Northwest should be reviewed to pinpoint useful lessons about how to organize and provide primary care services more efficiently to underserved populations. I was intrigued by his suggestions that the National Health Service Corps should permit physicians to work part-time to work off their educational debt. And I can see that more attention to the needs of spouses