Community Oriented Primary Care New Directions for Health Services Delivery (1983) / Chapter Skim
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Elements of COPC in the UMWA Health and Retirement Funds Program
Elements of COPC in the UMWA Health and Retirement Funds Program
Pages 217-221
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From page 217... ...
In 1946-1950, when the program was first established, the UMWA leadership decided not to buy care for its members via the traditional health insurance mechanisms on the market as most other unions did at that time, but instead they built their own program based on the social needs of the defined population. The genesis of the program is to be found in the exceedingly poor health conditions extant in large areas of the industry, in the 1930s and 1940s, that is in the Appalachian states.
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From page 218... ...
Where the resources of the traditional, existing market system were used—which applied to a majority of beneficiaries the Funds established a structure of quality and CoSt controls, such as participating lists, prior authorization, restriction of payment to properly qualified providers, and retainer payments. Where the concentration of beneficiaries allowed and/or conditions of inadequate medical resources necessitated, the Funds established an alternative delivery system of nonprofit hospitals and clinics with full-time, salaried, group practice staffs.
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From page 219... ...
SOME LESSONS FOR COPC Although the history of the UMWA program exhibits some significant successes in developing COPC-type elements, this same history does not encourage anticipation of major further COPC development in the United States without some basic changes in national priorities. The Funds experience seems to be that the social service orientation necessary for COPC cannot be sustained in one industry by itself, in a competitive market economy.
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From page 220... ...
In light of diminishing levels of federal support of organized primary health care services, while it is technically true that the potential of COPC is not limited to publicly sponsored health centers, all organizational forms of practice- including hospitals, academic health science centers, private group practices, etc.—could well concern themselves with a community focus; nevertheless, the UMWA Funds history and the history of the U.S. delivery system generally suggest the private sector will not provide the large necessary funding.
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From page 221... ...
But, I believe we can expect no major impact on health care in the United States until a national effort brings about a national program based on different premises and priorities.
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