State health care policymaking: the Tennessee Primary Care Act of 1973.

Departments of public health have played a relatively limited direct role in providing primary care to medically underserved areas, a function which has long been the province of the private medical practitioner. This article reports on the personal experiences of the author in investigating the circumstances which led the state of Tennessee to deviate from this norm with its Primary Care Act of 1973. The limited scope of the measure and the timing of its introduction, together with careful attention to the dynamics of health care politics, were critical to the passage of the Act. Even though considerable time has elapsed since this article was written, and increased interest in primary care is evident in other areas and at various levels of government, the obstacles and issues involved in providing care to underserved areas remain topics of debate in Tennessee and elsewhere.