Human Problems and the Organization of Health Care

In response to growing demands for medical care and to rising costs, various advocates have emphasized the need for greater efficiency in the organization and provision of care. While some controls on price, quality, and utilization are obvi ously necessary, there is a growing tendency among reformers to lose sight of the fact that medicine is a sustaining profession as well as a technical activity, and that there are limits to the extent to which medical service can be rationalized without undermining its more extensive social functions. The growing strains between the bureaucratization of medical care and the maintenance of a flexible, personal approach are examined. Using the Garfield model of health services as an example, the paper suggests how typical administrative solutions to the health care crisis may neglect the realities of how patients per ceive and use such services. Since increasing group organiza tion is viewed as inevitable, the paper concludes by considering bureaucratic mechanisms that might facilitate a reasonable balance between efficient organization and an appropriate response to the needs of the patient.