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October 6, 1993

Community-Oriented Primary Care: The Cuban Plan-Reply

JAMA. 1993;270(13):1548. doi:10.1001/jama.1993.03510130054030

In Reply.  —In health care provision, accountability is the ability of a system to provide justifying evidence that resources are being used appropriately to service the public's interest and needs. As stated in my article, the COPC model strengthens the social contrast between health care and society by directly linking the organization and the provision of services to population-based health needs.While the framework of COPC is a primary care practice with a population-based focus, the actual COPC model consists of five components: (1) a target community; (2) a community empowerment model; (3) health needs assessment;(4) health programs targeted to high-priority needs; and (5) an evaluation schema.1 As indicated by the Institute of Medicine2 evaluation of seven COPC practices, full implementation of all five components was nonexistent in the practices evaluated.As for community and migrant health centers and their commitment to COPC, Drs Ventres and Hale misinterpreted