title: Establishing a regional pediatric surgical service in the setting of universal health care: a glimpse into the future.
abstract: OBJECTIVE
  Increasing health care expense and rising numbers of uninsured Americans have led many to propose a national health insurance. This study describes the process, rationale, and requirements in creating a regional pediatric surgical service in the setting of a single-payer system.
  
  
  METHODS
  Our health care system consists of 10 medical centers providing comprehensive care to more than 3 million members. All services are provided by salaried physicians/practitioners to prepaid members. Before July 2004, pediatric surgical care was performed at multiple medical centers with many services contracted out. Starting July 2004, a multidisciplinary, comprehensive pediatric perioperative plan was established. Implementation has occurred in steps; current status and preliminary results are reviewed.
  
  
  RESULTS
  Strict guidelines for pediatric anesthesia and requirements for support services, personnel, and equipment were defined. Pediatric surgery is now performed at 3 community medical centers and 1 tertiary, teaching hospital. Operative cases were assigned to each center based on age, complexity, level of postoperative care, and location. A single high-volume, center for complex care has been established. Access to care was excellent; more than 90% of outpatient consultations were seen within 2 weeks. Utilization of services was 94% in 2006 and 98% in 2007. Physician and patient satisfaction were high. Additional pediatric surgeons have been hired and nearly all care has been internalized. Given the proximity to a major children's hospital, specialty services have not been duplicated.
  
  
  CONCLUSIONS
  Establishing a multidisciplinary, comprehensive pediatric perioperative plan provided standards for supporting pediatric surgical services at community hospitals. This regional service may be a model for the future of specialty care, especially in the setting of a single-payer system.
authors.affiliation: Division of Pediatric Surgery, Department of General Surgery, Kaiser Permanente, Los Angeles Medical Center, CA 90027, USA. slleemd@yahoo.com
authors.forename: Steven L
authors.initials: SL
authors.lastname: Lee
authors.forename: Roman M
authors.initials: RM
authors.lastname: Sydorak
authors.forename: Donald H
authors.initials: DH
authors.lastname: Marcus
authors.forename: Harry
authors.initials: H
authors.lastname: Applebaum
mesh_terms: D002140:California; D005544:Forecasting; D006801:Humans; D009313:National Health Programs / Q000639:trends*; D019982:Organizational Case Studies; D010348:Patient Care Team / Q000458:organization & administration; D010372:Pediatrics / Q000639:trends*; D012041:Regional Medical Programs / Q000458:organization & administration / Q000639:trends*; D013514:Surgical Procedures, Operative; D014481:United States; D019472:Universal Health Insurance / Q000639:trends*