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This paper discusses the Meharry Medical College Study of Unmet Needs designed to measure the effectiveness of alternative health care delivery systems: (a) comprehensive care with broad outreach, (b) comprehensive care with limited outreach, and (c) traditional care. Unmet needs are defined as the differences between services judged necessary to deal appropriately with health problems and services actually received. The central hypothesis is that comprehensive health programs will be more effective than traditional care in reducing unmet needs. Unmet needs are viewed as measures of program outcome and are one of several types of sociomedical indicators which use factors other than biomedical or biological states as measures of outcome. The distinction is made between unmet needs are discussed and the relatively limited focus of these is contrasted with the more comprehensive Meharry approach. Household interviews and clinical examinations provide the data base for deriving professional judgements of unmet needs in the medical, dental, nursing, and social services areas. The Meharry work suggests several areas in which further work on unmet needs would be useful.

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In recent years there has been an increasing tempo of organization of health workers, for various reasons, and at all levels-professional and technical; skilled and relatively unskilled. This trend to increased organization for collective action through professional associations or trade unions cuts across the entire health sector. In spite of this activity, it is important to emphasize that the great majority of health workers in the United States are not organized into collective bargaining units at the present time.'Over the past two decades there has also been a growing tendency to strike action, slowdowns, and work-to-rule. Active participants in these movements have included all types of health workers-and all kinds of health institutions have been affected, including short-and long-term hospitals and nursing homes, irrespective of their sponsorship, health departments and agencies, and free-standing ambulatory care centers. Working to rule, slowdowns and strikes represent the concerted collective withholding of their labor by groups of workers for purposes of extracting certain concessions.2 These concessions are intended, in general, for the economic benefit of the strikers, but this is not always the case, as I shall note later.There seems to be little doubt that, over the next generation, the great majority of health workers, including physicians and other health professionals who do not already do so, will be working primarily in bureaucratic organizations. This is the result of the revolution in technology and social organization which has made the hospital and its satellites, group practices, and community health centers key focal points for the delivery of health care services. Increasingly, all health services will tend to come under public sector financing. Given this combination of forces, it is inevitable that the goals of health workers-irrespective of rank or category-will increasingly parallel those of workers in other fields. But there is a singular difference in the field of health care delivery (and in a few others): in order to protect life, the quality of the product has to be assured. At the same time, the rights of workers to organize also have to be protected.3 Conflicts and confrontations are inevitable.