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Washington. edu ) In 1980, Arnold Relman, former Editor of The New England Journal of Medicinenoted the emergence of the medical- industrial complex, a huge new for-profit industry ranging from proprietary hospitals and nursing homes to diagnostic services, medical devices, hemodialysis, the pharmaceutical industry, the insurance industry, home care, and many other related proprietary activities. He issued this warning 23 years ago: This new ‚medical-industrial complex‚ may be more efficient than its nonprofit competition, but it creates the problems of overuse and fragmentation of services, overemphasis on technology, and ‚cream-skimming,‚ and it may also exercise undue influence on national health policy. Closer attention from the public and the profession, and careful study are necessary to ensure that the ‚medical-industrial complex‚ puts the interests of the public before those of its stockholders. This article has 3 main goals: (1) to examine the extent of corporate transformation within the medical-industrial complex today; (2) to assess the impact of these changes on health care costs and primary health care access; and (3) to offer some suggestions for more effective cost containment as a means to make health care more affordable and to improve access to care.

The vessel reached St. Petersburg with pilot assistance on Feb.]