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Concern for reliable medical care data is frequently expressed at the federal level of government. Such data are, however, already widely collected at the local level of government. This paper demonstrates how a Department of Pediatrics can build a local data system for the child population, using household interviews and supplementing these with data abstracted from the local Medicaid payment files. The latter approach is of special importance for the evaluation of health centers designed to serve specific poverty areas. Major changes in the child health care system occurred in 1969. A new health center became fully operative in one of the two local poverty areas. Medicaid eligibility criteria were changed, the welfare rolls increased, and private practitioners began to withdraw from the Medicaid program after a 20 per cent fee cut was enacted. The Medicaid payment files of 1968 and 1970 were therefore compared to study the effects of these changes. The health center provided 10,000 more services to children in the target area, which led to a decrease of 2,000 hospital clinic visits, 500 private doctor visits, and 300 private dentist visits. In contrast, the second poverty area had 2,000 more private doctor visits, 1,000 more private dentist visits, 400 more hospital clinic visits and 600 more other clinic visits.

The trends of modern medical care delivery and the roles of health and sick-care are discussed as they relate to decision-making in medical research, education and patient-care. The requirements upon medical data and information, as they apply to decisions in medical research and patient-care, are described and a theoretical description of a new approach to the evaluation of medical data is presented. The approach employs predictors, indicators and health index in performing symptomatology-oriented (as opposed to diagnosis-oriented) evaluations. The application of this technique to patient-care decision-making in a multiphasic screening environment will be described in a later paper.

ceptual approaches unique to psychology and psychiatry into the arena of general medical care and research. It is the purpose of this paper to examine in greater detail how the above objectives have been accomplished in the past, how they may be extended, and to elaborate some of the difficulties encountered in such an activity. With several notable exceptions, the history and development of psychiatry has been to isolate, if not alienate, itself from the mainstream of medical practice. Indeed, approaches to behavioral disorders have always been and still are frequently relegated to a position somewhere between religion and medicine. The explanation for this lies within the anxieties that bizarre and inexplicable behavior causes in all of us. We, in turn, are utilizing our own defenses to keep our own potential for similar behavior at bay. Without an understanding of perverse behavior, man has called upon his less rational processes to ascribe such behavior to unknown demonic forces beyond his comprehen/sion and control. The various traditions that have developed to understand behavior have for the most part developed within a scientific framework after the traditions in the rest of medicine. However, the hypotheses of the new psychologic disciplines have acquired a force of their own that has taken them far afield from their medical descent. Nowhere is this more apparent than in the tradition of psychoanalysis, a discipline that had its beginning as a firmly based biologic science. Whether or not explanations for abnormal behavior have derived from a scientific foundation or a more mi~taphysical one, the net results in almost all instances have been to separate psychiatry from the rest of scientific medicine. This is equally the case whether the school of psychiatry characterizes itself as basically organic, social, behavioral, or psychoanalytic.