The C. J. Shanaberger Lecture: pitfalls in the corporatization of health care.

The Parkland Health & Hospital System is owned by the community and must be responsive to the community's most vulnerable populations. It serves as the safety net for all the residents of Dallas County for critical care, but particularly has addressed its attention over the last decade on providing the primary care and preventive medicine infrastructure in underserved areas of the community. We are striving to create a community-responsive servant organization, competent to partner with the various communities in which our clinics are located. We intend to promote the values of those early nonprofit HMOs and establish a covenant relation with our patients and the community. It is in the spirit of the "third generation" of managed care that we must address enrolled populations, while not ignoring the unenrolled populations in the process. We bring value to the table by investing savings into prevention not just higher CEO salaries or stock dividends. We strongly believe that to be community-responsive we have to provide care to the individual person in a patient-centered way. We understand that our institution must also nurture a "relationship-centered" partnership with the community. This requires a willingness to dialogue with the community. We further believe that Parkland's COPC and nonprofit HMO represent opportunities for the training of physicians and for conducting relevant community-based health systems and clinical research. We must remain competent and able to measure what we do and understand the limits of our power and the power that's within communities to improve health. We must recognize that autonomy will sometimes be in conflict with other values and with the needs of populations of patients. Perhaps one of the major reasons that we are in such a dilemma in the United States regarding health care, and whether or not it should be a right available to all, is in our failure to understand the connection we have to one another.