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Health Care Policy: A Clinical Approach
January 11, 1995

The Organization of Health Care

Author Affiliations

From the Department of Family and Community Medicine (Drs Grumbach and Bodenheimer) and the Institute for Health Policy Studies (Dr Grumbach), University of California, San Francisco.

JAMA. 1995;273(2):160-167. doi:10.1001/jama.1995.03520260082038

Frank Hope has walked with a limp since his attack of polio in the 1940s. When he watches his daughter run after her young toddler, he experiences a sense of gratitude that the era of vaccinations has protected his child and grandchild from such a disabling infection. He recalls the sense of excitement that gripped the nation as the Salk polio vaccine was first tested and then adopted into widespread use. In Frank's mind, these types of scientific breakthroughs attest to the wonders of the US health care system.

Frank's grandson attends a day-care program. Ruby, a 2-year-old girl in his program, was recently hospitalized for a severe case of measles complicated by pneumonia. She spent 2 weeks in a pediatric intensive care unit, including several days on a respirator. She had not received her measles immunization, normally scheduled for 15 months of age. Ruby's mother works full-time as a

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