CORRESPONDENCE
Program for health systems management To the editor: After 6 weeks of the Harvard school of public health's program for health systems management one concludes that life is not so different in the United States after all. They have their problems with health care just as we do, but some of their solutions are very different from ours. And who's to say who's right? It doesn't matter much, for the truth is that there are many unhealthy people in both countries who are poorly served by the health care industry. Confusion undermines the health care industry in the United States. The definition of health is confused. There is confusion surrounding the basic goals of the industry. There is confusion between rights and privileges and between providers and consumers. There is even confusion among the providers. The only consensus is that health care consumes more than 8% of the American gross national product and that the industry has become very expensive and very inefficient. The most obvious response to the problem is the growth of government involvement. There is such a proliferation of agencies and legislation that some believe we will surely drown in our own alphabet soup, but government has never been particularly successful in running any industry in the United States - and from our Canadian experience we must admit that this concern is not unfounded. Another response to the dilemmas of health care is to be found on the plush campus of the Harvard business school in Boston. Harvard is a unique educational institution in North America and it is fair to say that the Harvard business school and the Harvard Contributions to the Correspondence section are welcomed and if considered suitable will be published as space permits. They should be typewritten double spaced and, except for case reports, should not exceed 1½ pages in length.
school of public health have come up with a unique program. The program for health systems management is a reasoned and intelligent approach to the problems besetting us all. It is intensive and demanding; for 6 weeks one does little other than read and digest a multitude of cases and engage in sometimes interminable discussions. Above all, it is an attempt to reconcile the divergent interests involved in health care and this is illustrated by the selection of the participant group. This year there were 54 participants, most from the United States; the remaining participants represented more than 10 countries. More than one third of the participants were doctors (from all fields) and many were administrators, representatives from the nursing profession, and home care consultants, from proprietary hospitals, pharmaceutical companies and, of course, government. All shared a common concern for some aspect of health care, and the divergence of interests made for many fascinating and enlightening discussions. It was heartening to participate in a group that was able to debate and discuss strongly held beliefs and at times reconstruct them. In fact the participants were the highlights of the program and one felt that the resources of the group were not as well used as they might have been. Drs. Duncan Newhouser and Dr. Eoin Trevalyan organized a faculty that presented an overview of the range of material of interest to health care workers. There was emphasis on issues and policy, but matters such as organizational theory, systems theory and finance control, valuation and marketing were not neglected. All the material was based on case and ancillary readings. There were frequent visitors and opportunities for the presentation of various viewpoints from the group. One can hardly expect revolution to develop on the campus of the Harvard business school but I cannot imagine
1076 CMA JOURNAL/DECEMBER 4, 1976/VOL. 115
any group of people undertaking a more intensive inquiry. There was an endless succession of questions to be considered. How does one reconcile the divergent interests of medical economics and patient care? How does one approach the classic economic question of scarce resources and insatiable demands? What is the real cost of our activity in terms of both dollars and opportunities missed? There were few answers, of course, and for some this was a cause for concern. However, one interesting conclusion was reached: the group argued, with tongue in cheek, that we should not reasonably expect people to pay any more than 10% as, traditionally, this has been the maximum that people are willing to pay for their church. Perhaps there is truth in the jest. PETER J. ROBERTS, MD International Grenfell Association St. Anthony, Nfld.
Emotional "unhealth" To the editor: The editorial and scientific article in the Aug. 21, 1976 issue of CMAJ (pages 293 and 311) on psychiatric illness in the medical profession were as necessary as they were upsetting. I am certain that definable psychiatric disorders and suicide are simply the tip of the proverbial iceberg. In 1975 an article appeared in the undergraduate medical magazine at the University of British Columbia in which some of the personal and universal ravages of medical training and their aftermath were detailed.1 There was a good deal of discussion among the undergraduates at that time but barely a whisper from the practising staff. Coincidentally (or was it?) there was a beautiful article by M. Fanning in the same issue of the Journal (page 361) describing the traditional practice of medicine in Tibet. Fanning pointed out that in this system the doctor plays
Program for health systems management To the editor: After 6 weeks of the Harvard school of public health's program for health systems management one concludes that life is not so different in the United States after all. They have their problems with health care just as we do, but some of their solutions are very different from ours. And who's to say who's right? It doesn't matter much, for the truth is that there are many unhealthy people in both countries who are poorly served by the health care industry. Confusion undermines the health care industry in the United States. The definition of health is confused. There is confusion surrounding the basic goals of the industry. There is confusion between rights and privileges and between providers and consumers. There is even confusion among the providers. The only consensus is that health care consumes more than 8% of the American gross national product and that the industry has become very expensive and very inefficient. The most obvious response to the problem is the growth of government involvement. There is such a proliferation of agencies and legislation that some believe we will surely drown in our own alphabet soup, but government has never been particularly successful in running any industry in the United States - and from our Canadian experience we must admit that this concern is not unfounded. Another response to the dilemmas of health care is to be found on the plush campus of the Harvard business school in Boston. Harvard is a unique educational institution in North America and it is fair to say that the Harvard business school and the Harvard Contributions to the Correspondence section are welcomed and if considered suitable will be published as space permits. They should be typewritten double spaced and, except for case reports, should not exceed 1½ pages in length.
school of public health have come up with a unique program. The program for health systems management is a reasoned and intelligent approach to the problems besetting us all. It is intensive and demanding; for 6 weeks one does little other than read and digest a multitude of cases and engage in sometimes interminable discussions. Above all, it is an attempt to reconcile the divergent interests involved in health care and this is illustrated by the selection of the participant group. This year there were 54 participants, most from the United States; the remaining participants represented more than 10 countries. More than one third of the participants were doctors (from all fields) and many were administrators, representatives from the nursing profession, and home care consultants, from proprietary hospitals, pharmaceutical companies and, of course, government. All shared a common concern for some aspect of health care, and the divergence of interests made for many fascinating and enlightening discussions. It was heartening to participate in a group that was able to debate and discuss strongly held beliefs and at times reconstruct them. In fact the participants were the highlights of the program and one felt that the resources of the group were not as well used as they might have been. Drs. Duncan Newhouser and Dr. Eoin Trevalyan organized a faculty that presented an overview of the range of material of interest to health care workers. There was emphasis on issues and policy, but matters such as organizational theory, systems theory and finance control, valuation and marketing were not neglected. All the material was based on case and ancillary readings. There were frequent visitors and opportunities for the presentation of various viewpoints from the group. One can hardly expect revolution to develop on the campus of the Harvard business school but I cannot imagine
1076 CMA JOURNAL/DECEMBER 4, 1976/VOL. 115
any group of people undertaking a more intensive inquiry. There was an endless succession of questions to be considered. How does one reconcile the divergent interests of medical economics and patient care? How does one approach the classic economic question of scarce resources and insatiable demands? What is the real cost of our activity in terms of both dollars and opportunities missed? There were few answers, of course, and for some this was a cause for concern. However, one interesting conclusion was reached: the group argued, with tongue in cheek, that we should not reasonably expect people to pay any more than 10% as, traditionally, this has been the maximum that people are willing to pay for their church. Perhaps there is truth in the jest. PETER J. ROBERTS, MD International Grenfell Association St. Anthony, Nfld.
Emotional "unhealth" To the editor: The editorial and scientific article in the Aug. 21, 1976 issue of CMAJ (pages 293 and 311) on psychiatric illness in the medical profession were as necessary as they were upsetting. I am certain that definable psychiatric disorders and suicide are simply the tip of the proverbial iceberg. In 1975 an article appeared in the undergraduate medical magazine at the University of British Columbia in which some of the personal and universal ravages of medical training and their aftermath were detailed.1 There was a good deal of discussion among the undergraduates at that time but barely a whisper from the practising staff. Coincidentally (or was it?) there was a beautiful article by M. Fanning in the same issue of the Journal (page 361) describing the traditional practice of medicine in Tibet. Fanning pointed out that in this system the doctor plays
