Challenge to the City Hospitals

Abstract
EMERGENCY and outpatient treatment has continued to perplex American hospitals. Emergency rooms are packed with "nonurgent"1 patients. Costs per visit soar, increasing the deficit of dealing with the indigent2; outpatient visits increase by 20 per cent in one decade.3 Medical education becomes sandwiched between the burden of handling the community's sick and the pressures of research. And hospital planning and reform seem to move slowly.These problems are acutely felt in the large city hospital affiliated with a university teaching center. The young house officer soon realizes that he is operating in a matrix whose determinants are the patients, . . .

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