The future of primary care in America.
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Biomedical subjects
Publications and source records attributed to F Mullan.
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From its work in immigration and rural health to its fight against smoking and AIDS, the U.S. Public Health Service has stood on the cusp of science and politics. As the PHS looks forward to the year 2000, a new book details its two centuries of service and its ongoing role in the health of the nation.
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Most of the improvement--both absolute and relative--in the health status of black Americans over the past two decades can be traced to major gains in access to health care services. Public payment programs, most notably Medicaid and Medicare, have not only reduced financial barriers, but have also combatted those of racial discrimination. Other federal programs supporting targeted local services have been especially effective in reducing infant mortality. But the redistributive effects have been uneven and unequal across populations; many categorical gaps remain and increasing numbers are potentially without access to essential primary care services.
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Long- and short-term cancer survivorship presents a variety of problems of readjustment and readaptation to nonmorbid life. Foremost among these problems are the fear of recurrence, learning to live with compromise, and economic and social shunning. Since most of these problems are predictable events in the recovery phase, it is proposed that educational interventions be developed and used systematically in order to buffer the worst aspects of these experiences and promote mental as well as physical healing in the cancer patient.
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Medical student aid programs tied to a service commitment are in operation in 31 states. The programs provide various options for students to pay back the financial support given by the state, the most popular form being cancellation of the financial obligation to the the state if a service commitment is fulfilled. Although the statutory language and program literature claim a major objective of the programs to be the provision of manpower to underserved areas, lenient "buy-out" provisions and small awards relative to the total tuition have caused these programs to be used as sources of low-interest loans. Moreover, states do not provide subsidies to promote service in unattractive areas; thus, there is little reason for physician graduates to locate in low-income areas. State cooperation with the federal National Health Service Corps Scholarship Program, which does provide subsidies to physicians practicing in underserved areas, may provide the states a strategy for meeting their legislative objectives of providing physicians for the underserved.
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