The evolution of a contemporary academic health care system

R. W. Crichlow
Department of Surgery, Dartmouth-Hitchcock Medical Center, Lebanon, New Hampshire, USA.

The story I wish to tell today is of the emergence, over the last two centuries, of an integrated academic health care delivery system from the foundations of this country's fourth medical school, New Hampshire's first major hospital, and a multidisciplinary practice group, unique in its time. I will trace the covergence of each of these into a system that we offer as an answer to the contemporary puzzle of how to provide the best available care at value and still support the academic missions of education and research. We believe this to be the current delemma of American medicine, and while our answer may not be either successful or universally applicable, we are committed to the attempt. As background, let me provide some perhaps familiar details of the growth of these Hanover [NH] and Lebanon [NH] institutions.