Henry J. Kaiser's Legacy EDGAR F. KAISER* ON MY FATHER'S eighty-fifth birthday, just a few months before he died, he was talking with some reporters about his achievements and the enterprises he founded during his long and productive lifetime. "Of all the things I've done," he told them, "I expect to be remembered only for the Hospitals and Health Plan. They're the things that are filling the people's greatest need-the need for good health care at a cost that the average family can afford." My father constantly urged us to encourage other business organizations to turn their talents to sponsoring new approaches to medical care. He deeply believed that different approaches-new ideas-were not only healthy for the public but would provide us with competition and so improve our own program. He believed, too, that if others would expand on the prepaid group practice approach, then new innovations would develop. As a result the pattern, itself, would be improved and strengthened-for the benefit of the people. This three-day meeting and the volume based upon it represent an effort to provide an overview of the Kaiser-Permanente program. By so doing, we hope to stimulate a two-way exchange. All of us within Kaiser-Permanente are somewhat sensitive, in describing our health care delivery system, about leaving any implication or suggestion that we have produced the perfect model-the panacea for filling this nation's health care needs. We all know the far-reaching complexities, problems, and opportunities in financing and delivering health care services to all Americans. The shortage of medical manpower, the staggering problems of poverty, the inequities and shortcomings in our social welfare programs, the rising costs, and the many competing demands on our national resources: These are but a few of the more obvious issues. Our own capacity for growth depends on the supply of four basic resources— doctors, management, members, and facilities financing. In all of our four established regions, health plan membership periodically closes. We temporarily fall behind in meeting the demand for enrollment-not because of a lack of funds for facilities expansion nor because of a shortage of management talent-but because of the shortage of young doctors. This is a national problem of increasing proportions. Personally, I am optimistic that we will succeed in overcoming these enormous obstacles. One clear reason-in my view-is the response of the medical schools to this symposium. Chairman, Board of Directors and Chief Executive Officer, Kaiser Industries Corporation. 72-759 - 72 - 14 The Growing Demand for Information on Prepaid Group Practice CLIFFORD H. KEENE, M.D.* THE DECISION TO HOLD this symposium was born out of the fact that during 1969 and 1970 representatives of 38 medical schools visited us, hopeful that they might glean some insights that would help them to fulfill their growing desire to be involved in community health service. Demonstrative of this new attitude is a letter of January 14, 1971, from Dr. John A. D. Cooper, President, Association of American Medical Colleges, to Elliot L. Richardson, Secretary of Health, Education, and Welfare, elaborating the Association's views on various health issues. One of three major recommendations was "support for the development of health maintenance organizations by academic medical centers specifically aimed at areas of health distress." We suspect that the similarity of the HMO concept and Kaiser-Permanente is more than coincidence. We ourselves don't see Kaiser-Permanente as a panacea. We do see it as one valid solution to some long-standing problems. We do see it as an evolving method of organizing and delivering medical care which is intended to be responsive to the changing needs of the people it serves. We at Kaiser-Permanente are also impressed with the difficulties of altering existing patterns of medical care. We are aware of the talent, effort, and money needed to organize a medical care delivery system and it is because we are aware of these difficulties that we believe that medical schools must play an important role in bringing about change. Recognizing our shortcomings, yet with the thought that our experience might be helpful, we will attempt to provide some insight into what it is that we do, and how we do it. * President, Kaiser Foundation Health Plan and Kaiser Foundation Hospitals. The Kaiser Challenge to J. QUIGG NEWTON, JR.* AT A TIME WHEN our nation is caught in the throes of what properly has been described as a health care crisis, we are encouraged by the obvious growing interest of the nation's medical schools in accepting a significant role in the improvement of health care delivery. In our view, the active leadership of our academic health centers in the development of a more efficient and effective system is paramount. We are all aware of the fact that our medical schools cannot provide all, or even a large proportion of, the medical care needed in their respective areas. But they can and, in our view, they should involve themselves in studies and/or experimentation with health care delivery to a degree that emphasizes their genuine concern for the pressing problems before us. The education of medical and allied health personnel, a well accepted responsibility of our academic centers, will inevitably be incomplete if it does not include a component that will prepare these men and women properly for their interdependent roles on the health care teams that will be a key part of tomorrow's systems. The Commonwealth Fund views the problem of health care delivery in the United States as a major challenge. In affirmation of our interest, in the past five years we have made 40 grants, totaling $7.8 million, to support programs in this field. It is our expectation that this problem will continue to occupy a major share of our attention in the years immediately ahead. The superb record of the Kaiser-Permanente Medical Care Program is well known and needs no further plaudits from me. Nonetheless, I would be remiss were I not to express our admiration for the enormous contributions that the Kaiser organization has made in developing a high quality program of comprehensive care for over two million people. Inasmuch as pending legislation, which may well be enacted in the next year or two, has as a key feature the concept of HMO's-"health maintenance organizations"-the Kaiser example is all the more important. It constitutes a challenge to us all. The Commonwealth Fund is delighted to join with the Association of American * President, The Commonwealth Fund. 6 INTRODUCTION: BACKGROUND OF THE SYMPOSIUM Medical Colleges and the Kaiser-Permanente Medical Care Program in sponsorship of this volume, as well as the symposium upon which it is based, so that we can all learn, at first hand from the experts, the details of the most successful large scale program of prepaid care in the United States. The Concern of Medical Schools JOHN A. D. COOPER, M.D.* THE POOR STATE of the nation's health economy, the population's unmet health needs, the medical schools' financial plight: All bear witness to the reality of a health crisis! Americans are spending an increasingly large portion of their disposable income for health care, yet they are finding it more difficult to obtain care. We are all familiar with the many facets of the problems, and the real possibility of setting “the answer" into legislative concrete. The medical schools are indeed concerned. The health dilemma is directly opposed to their primary goal of better health for the American people. And the schools are looking for solutions-unfortunately at a time when most are in financial difficulty. But a better system for the delivery of health care is clearly called for-one that guarantees access, ensures quality, and contains costs. The academic medical centers must play an important role in determining the structure and organization of this system if they are to assure that the type of physician they educate will be able to work efficiently and effectively within the system. This symposium, in which we join the Commonwealth Fund and the KaiserPermanente Medical Care Program, will furnish important knowledge and insights not only for the academic medical centers but to all who are interested in improving the delivery of health care. The unique experiences of the Kaiser Foundation are valuable resources to those undertaking the development of comprehensive prepaid medical care programs. We are grateful to Dr. Clifford Keene and the Kaiser organizations for their willingness to share this knowledge and experience, and to Mr. Quigg Newton and Dr. Robert Glaser of the Commonwealth Fund for their important role in initiating the idea of the conference and for making it possible to publish this book under the editorship of Anne Somers. * President, Association of American Medical Colleges. |