Relationships between public and private providers of health care.

Fifteen local health departments that were identified as notable for their involvement in rendering personal health care were intensively studied along with their communities. Interviews with local medical care leaders and practitioners provided much of the study data. Three patterns characterized the relationships between the health departments and private providers in the communities. In one pattern, there were dual or parallel systems of care, both public and private, which were self-contained, with little planned linkage between them. In another pattern, the public and private sectors were interactive, relying on each other in deliberate ways for the exchange of services. In a third pattern, termed accommodative, the private and public sectors, although maintaining service separation, planned with each other for the establishment of complementary programs that would be responsive to community needs. Provision of health services of high repute was associated with all three of these patterns. Although tensions were not absent between public and private providers in the study communities, a climate of mutual support and good will appeared to characterize their relationships. In none of the health departments selected as outstanding, was an atmosphere of conflict with the private medical community reported.