A provider's view of prevention approaches in a prepaid group practice.

Kaiser Permanente's health care delivery system and its efforts to integrate public health preventive medicine and curative medicine are described. The author advocates an increased focus on prepaid delivery systems like Kaiser Permanente as the best vehicle to achieve the full promise of health screening, health education, and life-style modification. Because these systems have brought the proper incentives into alignment, prevention and health promotion have become effective tools to achieve cost containment goals. A number of Kaiser Permanente projects are highlighted that demonstrate integration of public health preventive medicine and curative medicine: the Northern California Region's uniform health appraisal examination, which is linked with health education and counseling; the Colorado Region's breast cancer screening program, which is expected to show a higher rate of early breast cancer detection than in the general population; cooperative efforts with two Northern California towns to reduce smoking through a community-wide project; educational theatre programs aimed at early intervention and education of children before high-risk behaviors have become established life-style; and research projects that are possible because of an integrated program. Also, several forces that could endanger integrated systems including cost control practices of employers and insurers, and public policy such as mandating specific benefits, are noted.