| Three types of health care system, the role of the physician in each, and the concepts precipitating the change from one to another are discussed. The three systems are: the hospital; comprehensive or community health care; and community health care involving the active participation of the community in decision-making. The first deals with a limited number of people, all of whom are seen by a doctor, whose role is primarily that of a clinician. The second deals with great numbers of people, many of whom are seen only by auxiliaries; the doctor's role is that of manager of the team of auxiliaries working under him, as well as clinician. The third, that of community self-determination, involves the doctor as a manager, a consultant, and a leader, reducing his role as a unilateral decision-maker and increasing his role as a public servant. The first becomes the second upon the realization that only a small part of the people in need of medical attention are seen and can be seen by the hospital. The second becomes the third when the community reaches a state of awareness wherein it is willing to take responsibility for the decisions affecting it. |