21st-Century Health Care — The Case for Integrated Delivery Systems

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Abstract
It was 1933. The United States was in the midst of a severe economic downturn that was to become the Great Depression. Data from 1929 showed that U.S. health care expenditures had reached 4% of the U.S. gross domestic product, a sum that was believed to threaten the country's financial recovery. After nearly a year of work, the Committee on the Costs of Medical Care, chaired by Dr. Ray Lyman Wilbur, the president of Stanford University, published its findings and recommendations.1 The first boldface recommendation read, “Medical service should be more largely furnished by groups of physicians and related practitioners, so organized as to maintain high standards of care and to retain the personal relations between patients and physicians.”