Showing papers on "Health care published in 1978"

Culture, Illness, and Care: Clinical Lessons from Anthropologic and Cross-Cultural Research

Abstract: Major health care problems such as patient dissatisfaction, inequity of access to care, and spiraling costs no longer seem amenable to traditional biomedical solutions. Concepts derived from anthropologic and cross-cultural research may provide an alternative framework for identifying issues that require resolution. A limited set of such con- cepts is described and illustrated, including a fundamental distinction between disease and illness, and the notion of the cultural construction of clinical reality. These social science concepts can be developed into clinical strategies with direct application in practice and teaching. One such strategy is outlined as an example of a clinical social science capa- ble of translating concepts from cultural anthropology into clinical language for practical application. The implemen- tation of this approach in medical teaching and practice requires more support, both curricular and financial.

Affective Disorders in a US Urban Community: The Use of Research Diagnostic Criteria in an Epidemiological Survey

Abstract: • The current point and lifetime prevalence rates of affective disorders, based on the application of Research Diagnostic Criteria to a US urban community sample, are reported. The affective disorders studied included major and minor depression, mania, hypomania, bipolar I and II, primary and secondary depression, schizo-affective disorder, depressive and cyclothymic personality, and grief reactions. Epidemiologic surveys that include treated and untreated persons to obtain rates of specific psychiatric disorders are needed for scientific purposes and health care planning.

Access to medical care in the U.S.: realized and potential.

Abstract: This paper seeks to provide a framework for understanding differential access to medical care in the U.S. population and to suggest ways to achieve equity of access. The framework is provided by a behavioral model of health services utilization which suggests a sequence of predisposing, enabling and illness variables that determine the number of times people will visit a physician. The model is operationalized using a path analytic technique. The data come from a national survey of the noninstitutionalized U.S. population conducted in late 1975 and early 1976. The results suggest services are generally equitably distributed since age and level of illness are the main determinants of the number of services people receive. However, remaining inequities might be reduced by providing people who report no regular source of medical care with a familiar entry into the health service system.

The biopsychosocial model and the education of health professionals.

Abstract: Over the past 50 years medical education has grown increasingly proficient in conveying to physicians sophisticated scientific knowledge and technical skills about the body and its abberations. Yet at the same time it has failed to give corresponding attention to the scientific understanding of human behavior and the psychological and social aspects of illness and patient care.’-‘ The average physician today completes his formal education with impressive capabilities to deal with the more technical aspects of bodily disease, yet when it comes to dealing with the human side of illness and patient care he displays little more than the native ability and personal qualities with which he entered medical school. The considerable body of knowledge about human behavior which has accumulated since the turn of the century and how this may be applied to achieve more effective patient care and health maintenance remains largely unknown to him. Neglect of this important dimension of the physician’s education lies at the root of frequently voiced complaints by patients that physicians are insensitive, callous, neglectful, arrogant and mechanical in their approaches. There undoubtedly are many reasons for this situation, but the most important is the pervasive influence of the biomedical model of disease. Rasmussen traces the philosophic origins of this model back three or four centuries when established Christian orthodoxy lifted the prohibition against physicians dissecting the human body as long as they did not presume to deal with man’s soul, morals, mind and behavior.’ This compact helped determine that Western Medicine be based upon dualism and reductionism. Dualism predicates separation of mind from body, of the psychological from the somatic, and provides no conceptual framework, other than reductionism, whereby the two can be related. Reductionism assumes that the understanding of a more complex entity can be best achieved by its analysis into its component parts and therefore that the complexities of life and biological phenomena, including behavior and mental processes, are to be studied and explained by the methods and in the language of physics and chemistry. Reductionism fosters a view of nature as involving interactions of discrete entities in a linear causal fashion, simple cause-and-effect relationships. This influence is expressed in the habit of speaking of diseases not as dynamic processes but as discrete entities the elimination of which awaits only discovery of their causes. The pledge of the ultimate conquest of disease, upon which biomedicine solicits support from the public, merely panders

The medical interview satisfaction scale: Development of a scale to measure patient perceptions of physician behavior

Abstract: Patient satisfaction is a variable of increasing interest to researchers, clinicians, and medical educators. Of several studies reviewed, only a few have shown evidence of careful methodology. Most surveys have focused on general evaluations of doctors and/or health care services or of a particular facility. The present article reports the development of a scale to measure patient satisfaction with an encounter with a physician or other primary care provider. Methods of item generation and pretesting are detailed. The overall reliability of the scale (Cronbach's coefficient alpha) is 0.93. The distribution of satisfaction scores is broader than that reported for other scales and approaches the normal in shape. Clinical and research applications of the scale are suggested.

Encyclopedia and Dictionary of Medicine, Nursing and Allied Health

Abstract: * Notes on the Use of This Book* Combining Forms in Medical Terminology* Color Plates* The Human Body-Highlights of Structure and Function* Atlases* Children with Distinctive Physical Features* Dermatology* Aging* Ophthalmology* Dentistry* Staining and Microscopy* Vocabulary* Windows* Encyclopedic Entries* Appendix (See List of Appendices below)* Credits* List of Appendices* SECTION 1: DIAGNOSTIC TOOLS*1-1 Major Diagnostic Categories*1-2 Diagnosis-Related Groups* SECTION 2: ASSESSMENT*2-1 Clinical Growth Charts for Children and Adolescents*2-2 DuBois' Body Surface Area Chart*2-3 Body Mass Index Table*2-4 Range of Motion*2-5 Summary of Normal Development in the First Three Years of Life (Based Largely on Gesell)*2-6 Bedside Calculations*2-7 Twenty-Four Hour Clock* SECTION 3: ANATOMY TABLES*3-1 Arteries*3-2 Bones:Listed by Body Region*3-3 Muscles*3-4 Nerves*3-5 Veins* SECTION 4: NUTRITION*4-1 Dietary Reference Intakes (DRIs): Recommended Intakes for Individuals, Vitamins Food and Nutrition Board, Institute of Medicine, National Academies*4-2 Dietary Reference Intakes (DRIs): Tolerable Upper Intake Levels (UL), Vitamins Food and Nutrition Board, Institute of Medicine, National Academies*4-3 Dietary Reference Intakes (DRIs): Recommended Intakes for Individuals, Elements Food and Nutrition Board, Institute of Medicine, National Academies*4-4 Dietary Reference Intakes (DRIs): Tolerable Upper Intake Levels (UL), Elements Food and Nutrition Board, Institute of Medicine, National Academies*4-5 Summary Examples of Nutrient Intake for Canadians* SECTION 5: TABLES OF WEIGHTS AND MEASURES*5-1 Measures of Mass*5-2 Measures of Capacity*5-3 Measures of Length*5-4 Avoirdupois--Metric Weight*5-5 Metric--Avoirdupois Weight*5-6 Apothecaries'- Metric Liquid Measure*5-7 Metric--Apothecaries' Liquid Measure*5-8 Conversion Table: Weight*5-9 Conversion Table: Metric and Apothecaries'*5-10 Temperature Equivalents: Celsius (Centigrade) and Fahrenheit Scales* SECTION 6: CHEMICAL TABLES*6-1 Chemical Elements*6-2 Elements by Atomic Numbers* SECTION 7: IMMUNIZATION SCHEDULES*7-1 Recommended Childhood Immunization Schedule-United States*7-2 Summary of Adolescent/Adult Immunization Recommendations*7-3 Routine Immunization Schedules for Children and Adolescents (Canada)*7-4 Recommended Routine Immunization of Adults (Canada)* SECTION 8: SYMBOLS, TERMS, AND ABBREVIATIONS*8-1 Symbols Commonly Used in Clinical Practice*8-2 Symbols Commonly Used in Pedigree Charts*8-3 Terminology for Microscopic Examination of Infected Material*8-4 Specialized Terms Used in Medical Records*8-5 Commonly Misinterpreted Words and Phrases*8-6 Acronyms for Selected Health Care Organizations, Associations, and Agencies*8-7 Professional Designations for Health Care Providers*8-8 Commonly Used Hospital Abbreviations*8-9 Abbreviations for Diseases and Conditions* SECTION 9: DENTAL CARIES AND RESTORATIONS*9-1 Black's Classification of Dental Caries and Restorations*9-2 Classification by Complexity for Dental Caries and Restorations*9-3 Simple, Compound, and Complex Designations for Dental Caries and Restorations* SECTION 10: REFERENCE INTERVALS FOR THE INTERPRETATION OF LABORATORY TESTS*10-1 Base SI Units*10-2 Derived SI Units and Non-SI Units Retained for Use with the SI*10-3 Standard Prefixes*10-4 Laboratory Reference Values: Clinical Chemistry, Toxicology, Serology*10-5 Laboratory Reference Values: Hematology and Coagulation*10-6 Laboratory Reference Values: Drugs-Therapeutic and Toxic* SECTION 11: PATIENT ADVOCACY AND RESOURCES*11-1 Poison Control Centers*11-2 Sources for Patient Education Materials and Support*11-3 Patient Advocacy Telephone Numbers* SECTION 12: PROFESSIONAL GROUPS AND BOARDS*12-1 Professional Organizations, Associations, and Academies*12-2 State Nurses Associations*12-3 State Boards of Nursing*12-4 Canadian Nurses Association Interest Groups and Contact Persons*12-5 Registering or Licensing Authorities for Nurses Working in Canada* SECTION 13: RESEARCH*13-1 The Nursing and Health Information Search: Some Approaches*13-2 A Guidesheet for Literature Searching*13-3 Accessing Health Information on the Internet* SECTION 14: NURSING VOCABULARIES*14-1 Nursing Minimum Data Set Elements and Definitions*14-2 Nursing Diagnoses of the North American Nursing Diagnosis Association (NANDA)*14-3 Nursing Interventions Classification (NIC)*14-4 Nursing Outcomes Classification (NOC): 260 Outcome Labels and Definitions*14-5 Home Health Care Classification System (HHCC System)*14-6 The Omaha System

Consumer-choice health plan (first of two parts). Inflation and inequity in health care today: alternatives for cost control and an analysis of proposals for national health insurance.

Abstract: The financing system for medical costs in this country suffers from severe inflation and inequity. The tax-supported system of fee for service for doctors, third-party intermediaries and cost reimbursement for hospitals produces inflation by rewarding cost-increasing behavior and failing to provide incentives for economy. The system is inequitable because the government pays more on behalf of those who choose more costly systems of care, because tax benefits subsidize the health insurance of the well-to-do, while not helping many low-income people, and because employment health insurance does not guarantee continuity of coverage and is regressive in its financing. Analysis of previous proposals for national health insurance shows none to be capable of solving most of these problems. Direct economic regulation by government will not improve the situation. Cost controls through incentives and regulated competition in the private sector are most likely to be effective.

Improving cognitive ability in chronically deprived children.

Abstract: Beginning at different ages in their preschool years, groups of chronically undernourished children from Colombian families of low socioeconomic status participated in a program of treatment combining nutritional, health care, and educational features. By school age the gap in cognitive ability between the treated children and a group of privileged children in the same city had narrowed, the effect being greater the younger the children were when they entered the treatment program. The gains were still evident at the end of the first grade in primary school, a year after the experiment had ended.

Measurement of work satisfaction among health professionals

Abstract: This paper describes a three-year research project that investigates the concept of occupational satisfaction of health professionals and suggests a method of measuring their level of occupational satisfaction. Additionally, the research examines factors defining occupational satisfaction important to health professionals. This process involves the development of a scale that measures the relative importance of various components of satisfaction, attitudes toward these components, and a weighted Index of Work Satisfaction. The methodology utilized in the development of this scale in an institutional setting with a sample of nurses is described, along with the transfer of this scale to three categories of health professionals involved in an outpatient setting. Responses from the physicians, nurses, and support staff in the ambulatory setting and responses from the hospital nurses indicate that the scale does measure occupational satisfaction of health professionals both in institutional and noninstitutional settings. Finally, statistical analysis of the original scale is reported and a revised scale is suggested for wider use.

The Distribution of Public Expenditure: The Case of Health Care

Abstract: In contrast to the amount of attention paid recently to the distribution of income and wealth, very little work has been done in Britain on the distribution of public expenditure. The gap is particularly wide in the case of the distribution of expenditure conferring "benefits-in-kind", such as that on the public provision of education or health care. There are a number of North American studies, particularly on education (see, for example, Gillespie, 1965; Hansen and Weisbrod, 1969; Pechman, 1970; and Judy, 1970). However the only recent British work is the annual estimates of tax and social services produced by the Central Statistical Office (see Harris, 1977); and these do not pretend to be an elaborate study of the distribution of expenditure on benefits-in-kind, the distribution being simply assumed to be equal for individuals of the same age and sex. This omission is a serious one. Since expenditure on benefits-in-kind is an important part of the so-called "social wage", and since the latter has become a focus of political attention (being used, for example, as a partial justification for the holding down of "private" wages), it seems important to establish exactly how such expenditure is distributed between different groups in the population. This paper is an attempt to do so for one element of the social wage: the distribution of public expenditure on the National Health Service (NHS). The paper relates public expenditure on the Health Service to the incidence of illness by socioeconomic group, in order to see whether the position in society where an individual is placed affects the amount of medical treatment he receives when he is ill. It is divided into five parts. In Section I the distribution of morbidity (or ill health) among different social groups in the population is discussed. In Section II an attempt is made to estimate the costs of the health service facilities used by different social groups, and to relate this to the morbidity of the groups. The calculations are very tentative, and should not be regarded as in any way definitive. In Section III some possible explanations for the results are discussed. In Section IV some of the implications of the results are explored, and the conclusions are briefly summarized in Section V. The paper is a substantially revised version of evidence submitted to the Royal Commission on the Health Service (Le Grand, 1976). Access to more data has permitted the use of a method of calculation superior to that used in the Royal Commission evidence. Reassuringly, the change in the methods of calculation has not greatly changed the results. For reasons described below the basic source for the data used in the calculations is the health section of the General Household Survey undertaken by the Office of Population Censuses and Surveys (henceforth OPCS),

Grief response of parents to neonatal death and parent participation in deciding care.

Abstract: We determined the grief response to neonatal death of 50 mother-father pairs by administering a queastionnaire and conducting a semistructured interview during the infant postmortem review. As measured by a parent grief score, maternal grief significantly exceeded paternal grief (t = 5.89, P .0001). Parent grief was not significantly related to birth weight, duration of life, extent of parentinfant contact, previous perinatal loss, parent age, or distance from the hospital of birth to the regional center (Pearson product-moment correlation coefficients). However, the attitudes and behavior of family, friends, and health care personnel in the hospital of birth often adversely influenced parent grieving. Of 39 mother-father pairs whose infants required respirator support, 18 participated in a group decision with their physician to withdraw respirator support when the prospects of infant survival seemed hopeless (limited respirator care group). No significant differences in parent grief scores were found (t tests) when the limited respirator care group was compared to those parents of infants who died despite uninterrupted respirator care. Our data suggest that informed parents can participate as partners with their physician in difficult infant care decisions, even when death results, and adjust to their loss with healthy grieving.

The concept of nursing

Abstract: The author contends that with the acceptance of health care as a universal human right has come a variety of national, provincial, state, and local systems for providing health care. An international network of rapid communications makes peoples everywhere aware of the variety of systems and the fact that some systems other than their own show better results, as measured by, for example, the infant mortality rate, or the incidence of venereal disease. Traditional roles for doctors, nurses, health educators, social workers and others are in question. To meet the needs of the people, health educators, physicians, social workers, nurses and all other categories of health personnel must constantly evaluate their roles and be ready to modify them for the common good and modify the programmes that prepare them for their work. While the roles of doctors, nurses and others are, necessarily, in these rapidly changing times, in · a fluid state, some health workers must provide a 24-hour service that helps human beings with their essential daily activities when they lack the strength, knowledge, or will, to carry them out unaided and to work towards the development of a healthy independence. This intimate and essential service is, in the author's opinion, the universal element in the concept of nursing. The most successful preparation of nurses will, the author argues, always include whatever gives them the broadest possible understanding of humanity and the world in which they live. It will also provide an opportunity to see expert nursing care given and to have the satisfaction of seeing the care they themselves give, hasten a person's recovery, help a person cope with a handicap, or die in peace when death is inevitable.

The advance of American nursing

Abstract: rom Hippocrates to Florence Nightingale: The Birth of Modern Nursing Untrained but Undaunted: The Women Nurses of the Blue and Gray The Founding of Early Schools of Nursing in America The Rise of Scientific Medicine and Its Impact on Nursing The Not-So-Gay Eighties and Nineties in Nurse Training Schools Gaslight and Shadow: The Practice of Nursing at the Turn of the Century Nurses and the War with Spain The Rise of Public-Health Nursing In Quest of Reform, 1909-1917 Days of Triumph: Nursing in World War I Boom and Bust, 1920-1933 Public-Health Nursing, 1912-1930 Depression Doldrums, 1930-1939 Nursing in the War for the World Postwar Reappraisal, 1945-1950 Nursing at Mid-century Minorities in Nursing Strive for Recognition Towards Professionalism Politics, Health and Nurses: The End of Innocence Nursing in Transition: The Growth of the Health Care Industry Danger and Opportunity: Health Care Reform and Nursin

Clinical Relevance of Anthropological and Cross-Cultural Research: Concepts and Strategies

Abstract: The author presents a method through which findings from anthropological and cross-cultural research can be applied to problems affecting patient care. The clinical social science approach emphasizes the distinction between disease and illness and cultural influences on the ways "clinical reality" is conflictingly construed in the ethnomedical models of patients and the biomedical models of practitioners. The relevance of such research extends beyond special clinical concerns arising from ethnic differences to ubiquitous problems that result from cultural influences on all aspects of health care. Consultation-liaison psychiatry is a particularly appropriate vehicle for introducing clinical social science into medical and psychiatric teaching and practice.

A manpower policy for primary health care.

Abstract: A National Academy of Sciences study of policy options for the supply of primary health-care manpower has produced a comprehensive set of recommendations. The study finds an adequate overall supply of physicians, but a shortage of primary health-care practitioners. It recommends maintaining current enrollment levels in medical schools and training programs for nurse practitioners and physician assistants and increasing the proportion of primary-care residents. To enhance the availability of primary care, the report advocates reimbursement for all physicians within a state at the same payment level for the same primary-care service, a reduction in payment differentials between primary-care services and nonprimary-care services, and reimbursement for educational and preventive services and for new health-practitioner services. The report supports a team approach in primary-care training and recommends that all medical students obtain clinical experience in a primary-care setting and some instruction in epidemiology and behavioral and social sciences.

Medicine and Slavery: The Diseases and Health Care of Blacks in Antebellum Virginia

Abstract: 'Widely regarded as the most comprehensive study of its kind, this volume offers valuable insight into the alleged medical differences between whites and blacks that translated as racial inferiority and were used to justify slavery and discrimination. In "Medicine and Slavery", Todd L. Savitt evaluates the diet, hygiene, clothing, and living and working conditions of antebellum African Americans, slave and free, and analyzes the diseases and health conditions that afflicted them in urban areas, at industrial sites, and on plantations'.

Persuasion and coercion for health: ethical issues in government efforts to change life-styles.

Abstract: Millions of people live unhealthy or even destructive life-styles. While the government is widening its involvement in life-style reform it may be faced with problems of an ethical nature. 3 possible goals of health behavior reform can be stated: 1) health as a goal in itself 2) fair distribution of burdens caused by illness and 3) maintenance and improvement of the general welfare. The government should refrain from interventions that could be considered coercive and/or paternalistic thus compromising the autonomy of the individuals and use health education whenever possible. Targest for government intervention should also be commercial and social forces that cause or support life-threatening behavior. One must also consider the fact that people who take chances with their health place a significant financial burden upon society but even if this behavior is voluntary there is not necessarily justification for intervention by the state. A national health insurance program with mandatory membership should be considered and also allow people with self-destructive life-styles to assume the cost of their habits. The most efficient way to reduce the cost of health care would certainly seem a drastic change in health behavior without relying on any coercive or intrusive programs. Health education while providing information alerts people to the consequences of their acts. There is however the danger that reform efforts may become moralistic being an imposition of the preferences and values of 1 group over another.

A legacy of Osler. Teaching clinical ethics at the bedside.

Abstract: The teaching of clinical medicine at the bedside is an enduring legacy of the Oslerian revolution in American education. The advantages of teaching clinical ethics at the bedside include dealing with actual cases to maximize personal accountability, reinforcing the relationship between technical competence and ethical decisions, involving the entire health care team, and possibly decreasing the resistance of the medical profession to formal medical ethics. The proposal to teach clinical ethics at the bedside is intended to indicate a primary role for ethicists and clinicians at different stages in the medical curriculum. During the preclinical years of medical school, ethicist-philosophers, assisted by clinicians, should assume primary responsibility for teaching medical ethics. During the clinical years, physicians, assisted by clinically informed ethicist-philosophers, should accept the primary obligation to teach clinical ethics at the bedside. (JAMA239:951-956, 1978)

A Marxist View of Medical Care

Abstract: Marxist studies of medical care emphasize political power and economic dominance in capitalist society. Although historically the Marxist paradigm went into eclipse during the early twentieth century, the field has developed rapidly during recent years. The health system mirrors the society's class structure through control over health institutions, stratification of health workers, and limited occupational mobility into health professions. Monopoly capital is manifest in the growth of medical centers, financial penetration by large corporations, and the "medical-industrial complex." Health policy recommendations reflect different interest groups' political and economic goals. The state's intervention in health care generally protects the capitalist economic system and the private sector. Medical ideology helps maintain class structure and patterns of domination. Comparative international research analyzes the effects of imperialism, changes under socialism, and contradictions of health reform in capitalist societies. Historical materialist epidemiology focuses on economic cycles, social stress, illness-generating conditions of work, and sexism. Health praxis, the disciplined uniting of study and action, involves advocacy of "nonreformist reforms" and concrete types of political struggle.

National health expenditures, fiscal year 1977.

Abstract: The Nation spent $163 billion for health care in fiscal year 1977 or $737 per person, according to preliminary figures compiled by the Health Care Financing Administration. This figure was 12 percent higher than spending for such purposes in the previous 12 months and represented an 8.8-percent share of the GNP. Public spending, which financed 42 percent of all health care in 1977, increased 11 percent while private spending rose 13 percent. Spending for hospital care went up 14 percent to $68.4 billion, and the total spent for physicians' services ($32.2 billion) reflected a 13-percent rise. Third-party payments financed 70 percent of all personal health care in the country.

The migrant presence: Australian responses, 1947-1977 : research report for the National Population Inquiry

Abstract: Preface..1 Definitions..2 Overview..3 Child Migrant Education in the Fifties and Sixties..4 From Migrant to Multicultural Education in the Seventies..5 Defining Migrant Health..6 Health Care..7 Trade Unions..8 Conclusion..Bibliography..Index..

Health care ethics: A theological analysis

Abstract: This fourth edition of "Health Care Ethics" provides a contemporary study of broad and major issues affecting health care and the ethics of health care from the perspective of Catholic teachings and theological investigation. It aims to help Christian, and especially Catholic, health care professionals solve concrete problems in terms of principles rooted in Scripture and tested by individual experience. Since the last edition of "Health Care Ethics", there have been many changes in the fields of health care medicine and theology that have necessitated a fourth edition. Ashley and O'Rourke have revised their seminal work to address the publication of significant documents by the Church and the restructuring of the health care system. The revised fourth edition discusses significant Church documents issued since the third edition. It includes "The Splendor of Truth" ( Veritatis Splendor), and "The Gospel of Life" ( Evangelium Vitae); "The Instruction on the Vocation of Theologians"; "The Catechism of the Catholic Church"; and, "The Revised Ethical and Religious Directives for Catholic Health Services". It examines the implications of managed care techniques. It probes such changes in the practice of medicine as the new emphasis on preventive care, the involvement of individuals in their own care, greater use of pharmaceuticals in psychiatry, and the greater role of genetics in diagnosis and prognosis. It explores the quest for more compassionate care of the dying. It updates the bibliography.

Obstetric, Neonatal, and Psychosocial Outcome of Pregnant Adolescents

Abstract: Obstetric, neonatal, and psychosocial outcomes were compared for 82 matched adolescents who had been pregnant, been delivered of an infant, and received health care in three sites in Rochester, New York. There were no major differences in obstetric and neonatal outcome of adolescents and their babies according to health site. Differences in outcome were expected in the psychosocial area where a specialized maternity project (Rochester Adolescent Maternity Project [RAMP]) offered more services. On follow-up two years later, school attendance and reliance on full or partial assistance were similar. Repeated pregnancy and postpartum use of contraception favored RAMP.

The three world systems of medical care: trends and prospects.

Abstract: Public assistance health insurance and national health service are the 3 basic systems of medical care operating in the world today. Public assistance is the dominant system in 108 countries 49% of the worlds population. These countries are located in Western Europe and North america and also include Australia New Zealand Japan and Israel. All are industrialized countries with a capitalist economy. The national health service is dominant in 14 countries with 33% of the worlds population. They include the 9 socialist countries in Europe 4 in Asia and Cuba and the Americas. All these countries are either industrialized or undergoing rapid industrialization. The United Kingdom and Sweden are among the 23 countries in which health insurance is dominant but they actually occupy intermediate positions which lie somewhere between health insurance and a national health service. The examples of the United Kingdom and Sweden suggest that while a national health service is the characteristic form of health care in socialist countries it is not necessarily limited to them. The dynamics of social reform in 2 major capitalist countries have already produced government health services which are still incomplete but have the potential of moving toward a fully developed national health service for everyone provided without charge by salaried physicians and other health personnel working in health centers hospitals and other facilities. In the United Kingdom and Sweden the development of the national health service has been supported by large sections of the population which do not have socialist commitments. The grounds for a national health service are logical; public assistance and national health insurance are simply not the way to provide health care. A national health service is the only reasonable approach.