The University of Chicago is a premier research university whose mission is fundamentally rooted in the creation of new knowledge and its dissemination through education. The Biological Sciences division extends this mission to the enlightened and compassionate care of patients in a humane and academic environment. Because financial matters so often intrude on conversations involving the latter, I believe it important to properly frame how we approach this critical area of endeavor.

First and foremost, patient care is central to the Division's academic mission of educating medical studetns, residents and fellows, which in turn directly feeds our discovery mission through robusst clinical research enterprise, the final link in the bench-to-bedside continuum, as well as innovative clinical programs.

Related to this, but subsidiary, are the financial considerations that surround modern health care delivery that compel us to be as knowledgeable and strategic as possible in delivering patient care. If reimbursement rates from insurance payors erode, we generate fewer resources from the same amount of clnical effort, and clinical department financial performance suffers. this in turn negatively impacts the health of clinical and research programs.

I believe that carefully balancing our academic mission with the financial realities of health care delivery is the best strategic approach. On the highest level, we must function as a complement to, and not a substitute for, community-based providers of health care, especially for more common diagnoses better treated in a lower-cost setting. Community providers that specialize in this type of care provide it more efficiently, and, by not competing against them to deliver routine care, we promote their existence. This in turn direectly enhances what we might term the "physiological capital" of our community health care economy.1

We should consider the physiological capital of community health care provision when thinking about our own patient care strategy. A careful balance will correctly apportion responsibility for care delivery among all community providers and free our patient care enterprise to do what we do best: make the most fundamental discoveries, educate the finest studetns, and treat the sickest and most complex patients.

1 The term physiological capital is borrowed from Robert Fogel, "Secular trends in physiological capital: implications for equity in health care", NBER working paper series no. 9771, National Bureau of Economic Research, 2003.

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