Skip to main content
Journal of the National Medical Association logoLink to Journal of the National Medical Association
. 1989 Jun;81(6):637–642.

Cardiovascular care in the urban melting pot.

R L Peniston
PMCID: PMC2625822  PMID: 2746685

Abstract

The widespread prevalence of cardiovascular diseases does not spare poor or heterogeneous urban communities. Since the inflationary spiral of health care costs has continued unabated, it will require intentional and creative maneuvers to preserve and develop new or existing programs which do not deny ready access to quality care for all classes. It is the opinion of the author that the present health care system promotes indifference on the part of health care providers and the purveyors of technology. The traditions of altrusim in medicine should be extended to health systems planning at the institutional and regional level. Although preventive medicine is a vital public issue, it is not the only priority agenda for populations experiencing already existing cardiovascular derangements. The private practice paradigm is an obsolete and inflation promoting system for the delivery of complex tertiary care. Modern cardiovascular diagnostics and therapeutics require efficient and economical team efforts. If the few remaining historically black medical centers are to properly serve a heterogeneous base, innovation and reorganization are inevitable.

Full text

PDF
637

Selected References

These references are in PubMed. This may not be the complete list of references from this article.

  1. 19th Bethesda Conference. Trends in the practice of adult cardiology: implications for manpower. October 15-16, 1987, Bethesda, Maryland. Proceedings. J Am Coll Cardiol. 1988 Sep;12(3):821–868. doi: 10.1016/0735-1097(88)90329-4. [DOI] [PubMed] [Google Scholar]
  2. Barsky A. J. The paradox of health. N Engl J Med. 1988 Feb 18;318(7):414–418. doi: 10.1056/NEJM198802183180705. [DOI] [PubMed] [Google Scholar]
  3. Cooper R. Cardiovascular mortality among blacks, hypertension control, and the reagan budget. J Natl Med Assoc. 1981 Nov;73(11):1019–1020. [PMC free article] [PubMed] [Google Scholar]
  4. Goldman L., Cook E. F. The decline in ischemic heart disease mortality rates. An analysis of the comparative effects of medical interventions and changes in lifestyle. Ann Intern Med. 1984 Dec;101(6):825–836. doi: 10.7326/0003-4819-101-6-825. [DOI] [PubMed] [Google Scholar]
  5. Gray B. H., McNerney W. J. For-profit enterprise in health care. The Institute of Medicine Study. N Engl J Med. 1986 Jun 5;314(23):1523–1528. doi: 10.1056/NEJM198606053142335. [DOI] [PubMed] [Google Scholar]
  6. Gustavson W. H. Physician reimbursement: a payer's perspective. Bull Am Coll Surg. 1988 Jun;73(6):4–7. [PubMed] [Google Scholar]
  7. Himmelstein D. U., Woolhandler S., Harnly M., Bader M. B., Silber R., Backer H. D., Jones A. A. Patient transfers: medical practice as social triage. Am J Public Health. 1984 May;74(5):494–497. doi: 10.2105/ajph.74.5.494. [DOI] [PMC free article] [PubMed] [Google Scholar]
  8. Kennedy E. M. Congressional concerns about physician supply. J Med Educ. 1988 Feb;63(2):117–120. doi: 10.1097/00001888-198802000-00005. [DOI] [PubMed] [Google Scholar]
  9. Kennedy J. W., Atkins J. M., Goldstein S., Jaffe A. S., Lambrew C. T., McIntyre K. M., Mueller H. S., Paraskos J. A., Weaver W. D. Recent changes in management of acute myocardial infarction: implications for emergency care physicians. J Am Coll Cardiol. 1988 Feb;11(2):446–449. doi: 10.1016/0735-1097(88)90114-3. [DOI] [PubMed] [Google Scholar]
  10. Lewin L. S., Eckels T. J., Miller L. B. Setting the record straight. The provision of uncompensated care by not-for-profit hospitals. N Engl J Med. 1988 May 5;318(18):1212–1215. doi: 10.1056/NEJM198805053181829. [DOI] [PubMed] [Google Scholar]
  11. McDermott W. Medicine: the public good and one's own. Perspect Biol Med. 1978 Winter;21(2):167–187. doi: 10.1353/pbm.1978.0048. [DOI] [PubMed] [Google Scholar]
  12. McPhedran N. T. Surgery in Canada: life under universal health care. Bull Am Coll Surg. 1988 Jun;73(6):21–22. [PubMed] [Google Scholar]
  13. Mechanic D. Cost containment and the quality of medical care: rationing strategies in an era of constrained resources. Milbank Mem Fund Q Health Soc. 1985 Summer;63(3):453–475. [PubMed] [Google Scholar]
  14. Miller S. M. Race in the health of America. Milbank Q. 1987;65 (Suppl 2):500–531. [PubMed] [Google Scholar]
  15. Parks P. RBRVS (resource-based relative value scale) update: how did we get to where we are? Bull Am Coll Surg. 1988 Jul;73(7):4–10. [PubMed] [Google Scholar]
  16. Reinhardt U. E. Economics, ethics and the American health care system, or why some people can't get decent care. New Physician. 1985 Oct;34(7):20-8, 42. [PubMed] [Google Scholar]
  17. Reinhardt U. E. Resource allocation in health care: the allocation of lifestyles to providers. Milbank Q. 1987;65(2):153–176. [PubMed] [Google Scholar]
  18. Relman A. S. Are voluntary hospitals caring for the poor? N Engl J Med. 1988 May 5;318(18):1198–1200. doi: 10.1056/NEJM198805053181811. [DOI] [PubMed] [Google Scholar]
  19. Schlesinger M. Paying the price: medical care, minorities, and the newly competitive health care system. Milbank Q. 1987;65 (Suppl 2):270–296. [PubMed] [Google Scholar]
  20. Schwartz W. B., Sloan F. A., Mendelson D. N. Why there will be little or no physician surplus between now and the year 2000. N Engl J Med. 1988 Apr 7;318(14):892–897. doi: 10.1056/NEJM198804073181405. [DOI] [PubMed] [Google Scholar]
  21. Secundy M. G. Allocation of scarce resources: some problems. J Natl Med Assoc. 1981 Aug;73(8):725–728. [PMC free article] [PubMed] [Google Scholar]
  22. Shortell S. M., Hughes E. F. The effects of regulation, competition, and ownership on mortality rates among hospital inpatients. N Engl J Med. 1988 Apr 28;318(17):1100–1107. doi: 10.1056/NEJM198804283181705. [DOI] [PubMed] [Google Scholar]
  23. Spratt J. S., Jr The physician's role in minimizing the economic morbidity of cancer. Semin Oncol. 1975 Dec;2(4):411–417. [PubMed] [Google Scholar]
  24. Stevenson R. H. The case of cardiovascular disease: evaluating complex health programs targeted at prevention, remediation, and rehabilitation. Eval Health Prof. 1984 Jun;7(2):157–180. doi: 10.1177/016327878400700203. [DOI] [PubMed] [Google Scholar]
  25. Tarlov A. R. Alan Gregg memorial lecture. The rising supply of physicians and the pursuit of better health. J Med Educ. 1988 Feb;63(2):94–107. doi: 10.1097/00001888-198802000-00003. [DOI] [PubMed] [Google Scholar]
  26. Wennberg J., Gittelsohn A. Variations in medical care among small areas. Sci Am. 1982 Apr;246(4):120–134. doi: 10.1038/scientificamerican0482-120. [DOI] [PubMed] [Google Scholar]

Articles from Journal of the National Medical Association are provided here courtesy of National Medical Association

RESOURCES