The end of an era? CMAJ 1997;157:360 © 1997 Canadian Medical Association A leading Canadian cardiac surgeon says we are witnessing "the end of an era" in health care in which hospitals and physicians in solo practice may require "endangered-species status." Dr. Wilbert Keon, director of the University of Ottawa Heart Institute, told physicians attending the recent annual meeting of the Canadian Association of Radiologists to expect hospitals to continue to close, medical staffs to continue to shrink and more patients to be cared for at home. "Large hospitals are dinosaurs," he said. "They're not cost-effective and they're dying." Keon suggested that the best way to reform the health care system is to develop integrated delivery systems to provide linked and coordinated health services. An integrated system of delivery would move the focus from hospitals to patients. Under his model various specialties would be grouped into "clusters" of health services such as child and family medicine or mental health and addiction medicine to improve communication and reduce the duplication of efforts and actions. "We need to . . . increase communication because until we accept the concept of integration the technology that is available to us is useless." Keon said physicians must speak out against "unreasonable" reforms to ensure that the best interests of patients are considered. He considers the regionalization of health care a potentially hazardous reform. "The problem with regionalization is that it could create various regional health czars, and that is very dangerous. -- Steven Wharry Send a letter to the editor responding to this article Envoyez une lettre à la rédaction au sujet de cet article | CMAJ August 15, 1997 (vol 157, no 4) / JAMC le 15 août 1997 (vol 157, no 4) |