Seems like there a couple of interacting problems but no one size fits all. It does seem like WalMart would be useful for high frequency low severity (adjusting

Seems like there a couple of interacting problems but no one size fits all. It does seem like WalMart would be useful for high frequency low severity (adjusting for risk of some high severity situations lurking in the intake). Trauma needs a trauma center, chronic progressive conditions benefit from Kaiser's approach (and have proven amenable to pharmaceuticals in many cases). It's not clear where to put cancer, if we can't screen and catch it early we don't seem to have a good answer. Stroke and heart attack may benefit from early intervention that's one time plus physical therapy follow up. There may be some more categories. Trauma (e.g. automobile accident, gunshot, explosion) => trauma center High Frequency Low Risk (for most: cough, cold, flu) => WalMart Chronic (heart disease, diabetes, high blood pressure, gout, glaucoma, cystic fibrosis) => pharmaceuticals / Kaiser pro-active healthcare Low Frequency High Risk (cancer, heart attack, stroke, appendicitis) => medical center / surgery Getting fewer people to smoke would have a huge impact. You also need to distinguish between an intervention that gives a 1 year old another 60-80 years of life and a 72 yr old another six months, they may cost the same but the first has a much stronger impact on society. I am not saying deprive anyone of medical care, but understand there may be an enormous cost for medical care in the last year of life. Good health is dying more slowly: good medical care doesn't save your life, it lets you die of something else a little (or a lot) later.