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Thomas R. Frieden, MD, MPH; Farzad Mostashari, MD, MSc

JAMA. 2008;299(8):950-952.

	Since this article does not have an abstract, we have provided the first 150 words of the full text and any section headings.

There is consensus about the need for fundamental change in the US health care system and there has been attention to the important problems of inadequate access and increasing costs. But the most serious shortcoming—that the nation's health system is not designed to maximize health—has been overshadowed. Individuals in the United States receive only about half the recommended medical services.¹ Only 43% of individuals with diagnosed diabetes,² 37% with hypertension,³ and 25% with hypercholesterolemia⁴ have adequate control of their disease; furthermore, less than 20% of smokers who try to quit receive assistance from their physicians, and only 2% are prescribed pharmacotherapy.⁵ Lack of effective primary health care is a public health problem that results in avoidable blindness, amputations, strokes, heart attacks, and premature death. Nearly 9 of 10 Americans with uncontrolled diabetes, hypertension, and hypercholesterolemia already have private or public health . . . [Full Text of this Article]

Author Affiliations: Dr Frieden is Health Commissioner for New York City; Dr Mostashari is Assistant Commissioner for the New York City Health Department's Primary Care Information Project.

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