Evaluation of an Ambulatory Medical-Care Delivery System

Abstract

We designed a medical-care-delivery system specifically to relieve the impaired access to care that has invariably accompanied the elimination of personal fees by prepaid plans, Medicare and other third-party payment plans. The solution involved the entry of patients through a paramedically staffed health-evaluation service that effectively separated patients into three basic health-status groups—the well and worried well (68.4 per cent); the asymptomatic sick (3.9 per cent); and the sick (27.7 per cent)—a process that permitted matching the needs of each group with appropriate services. The system achieved increased physician accessibility to new patients by 20 times, reduced the waiting time for new appointments from six to eight weeks to a day or two, saved physician time and costs for entry work-up by 70 to 80 per cent, reduced total resources used throughout the year by $32,550 per 1000 entrants, and proved very satisfactory to patients and generally so to staff. (N Engl J Med 294:426–431, 1976)