REPORT ON WORKSHOP A

The three following questions were examined by the group: What is the relationship between the hospitalsystem and primary care, between the reality and the ideal? What are health care needs and how are these are best met by primary care; what criteria should be used about which decisions should be made and by whom? The third question asked about the nature of the contract. We also considered, as indicated, whether the primary care situation differs crucially amongst industrialized nations, and if so, how? One of the early comments of the group seems to aptly describe the reality of the hospital system against that of primary care: “The hospitals keep people horizontal; primary care keeps them vertical, which is where they want to be.” This does lead, however, to an antagonistic system and part of the antagonistic system may be related to the economics of the whole health field. It was indicated here that there was greater reimbursement for hospitalization, that is, hospitalized patients, than there is to patients who go in to the primary care system. It therefore leads to people using the hospital rather than primary care. In the preparation of health care personnel the emphasis on institutional teaching was described as a “large vacuum cleaner” which pulls students in one direction, the direction being toward institutionalized care. The only way to counterblance that is with another “vacuum cleaner” in the opposite direction. I shudder to think of what happens to the patients and to the students. The training, therefore, was one of the factors seen as a reality against the primary care system at the present time. Economics not only influence trainbg but affect administration, too, from the point of view of structure where financing is such an important issue. In the instance of one nation it was stated that there was a political act which had favored primary health care, but this was counterbalanced by the fact that this political act was used as an axe rather than as an enabler. Good research was indicated as deficient and very difficult to obtain, so that the methods of health care which were alternatives to hospital-based care do not yet have a rational basis for consideration. It was stated that the Health Services Act in one country, the U.S.A., did provide for consumer representation on committees, but that although there was sometimes as much as 51 percent majority of citizens, this did not necessarily mean that they represented the best thinking of their communities. As indicated by other speakers, citizens’ contributions depend on their preparation and how they perceived and presented the needs, and that often they