URMC / Libraries / Edward G. Miner Library / Rare Books and Manuscripts / Archives and Manuscripts / Faculty Collections / Ernest W. Saward, Jr., M.D.

Ernest W. Saward, Jr., M.D.

Biography

For nearly four decades Ernest Welton Saward, Jr. was one of the nation’s most influential leaders in the organization and financing of health care and in the establishment of prepaid health plans.

Ernest W. Saward, Jr., M.D. A native of Brooklyn. N.Y., Saward was sent at age fifteen to the small village of Franklin, Delaware County, N.Y. for reasons of health. He boarded with a local family and attended the Delaware Literary Institute, from which he graduated in 1932. In his third year at Colgate University (1935), Saward was accepted by the University of Rochester School of Medicine & Dentistry. He would receive his undergraduate degree a year after completing his first year of medical school (1936).

Following graduation from the University of Rochester School of Medicine & Dentistry (1939), Saward completed residencies at the Barnes Hospital in St. Louis (1939-41) and the Peter Bent Brigham Hospital in Boston (1942-42). In 1943 he joined the Atomic Energy Project as Chief of Medicine at the Hanford Engineer Works in Hanford, Washington. After the Second World War, Saward left clinical medicine to begin his decades long involvement with one of the pioneering health maintenance organizations in the United States. Between 1945 and 1970 he served as Medical Director of the Permanente Clinic of Kaiser Foundation Hospitals and Kaiser Foundation Health Plan in Portland, Oregon. Between 1966 and 1970, Saward was also Project Director of the Kaiser Foundation’s Office of Economic Opportunity Health Project.

In 1970 Saward joined the faculty of the University of Rochester School of Medicine as Professor of Social Medicine in the Department of Preventive Medicine and Community Health. He also served as the medical school’s Dean for Extramural Affairs. Saward retired from the faculty of the University of Rochester School of Medicine & Dentistry in 1985.

Saward was a member of numerous boards and committees for such organizations as the National Health Insurance Council, the New York State Hospital Review and Planning Council, the National Academy of Sciences, and the U.S. Department of Health Education and Welfare, as well as serving as advisor to numerous regional health planning organizations. In 1987 he received the Gustav O. Lienhard Award of the National Institute of Medicine for his work in health care planning.

Ernest W. Saward, Jr. died at his home in San Jose, California on June 8, 1989. He had two sons and two daughters by his first marriage.

The Collection and Its Arrangement

The Saward collection came to the Edward G. Miner Library through the agency of his second wife, Elizabeth Saward. It is a comparatively small collection consisting of ten boxes occupying seven linear feet. The collection is nonetheless well representative of Saward’s work in prepaid health insurance and regional health planning. Boxes 1 and 2 consist entirely of the texts of oral presentations delivered by Saward between 1962 and 1985. Boxes 3 through 6 consist of his numerous publications – primarily journal articles and book chapters published between 1966 and 1985.

Box 7 contains a small but interesting body of correspondence from rather late in Saward’s career – the bulk of it spanning the years 1981 to 1986. Box 8 contains personal appointment calendars maintained between 1970 and 1986. Boxes 9 and 10 contain diplomas, awards and certificates.

Container List

BOX ONE – ORAL PRESENTATIONS

Folder 1: Experience with the recruitment of physicians to prepaid group practice medical care plans (1962)
Folder 2: Requirements for the creation and support of a medical care operation similar to that sponsored by the Kaiser Foundation (1962)
Folder 3: Identifying determinants of medical care utilization (1968)
Folder 4: [Untitled. Text begins:] Is there a general problem with the delivery system of medical services to the American people, or is the problem only with the urban and rural poor? (1968)
Folder 5: The organization and utilization of home health and extended care facility services in a prepaid comprehensive group practice plan (1968)
Folder 6: Address … at the opening session of the fourth annual Health Services Research Seminar, Johns Hopkins University (1969)
Folder 7: Paper for Medical Association of New Zealand biennial conference (1969)
Folder 8: The role of the medical school in medical service to the community (1969)
Folder 9: The health crisis, the university, and society (1970)
Folder 10: Prepaid group practice in the health crisis (1970)
Folder 11: The changing environment of prepaid group practice (1972)
Folder 12: The relationship between ambulatory care and medical education (1972)
Folder 13: Development of a prepaid group practice plan in a 24 month period in a metropolitan community (1973)
Folder 14: A presentation of the current education of the physician in the People’s Republic of China and the effect of the Cultural Revolution on this pattern (1973)
Folder 15: Toward an American health policy (1974)
Folder 16: [Untitled. Text begins:] The United States has undergone significant changes in the financing and structure of its health services in the past decade (1974)
Folder 17: A.M.A. address (1975)
Folder 18: PSRO as quality assessment (1975)
Folder 19: [Untitled. Text begins:] Thirty years ago this month, a very small group … felt that there was sufficient value to the community in offering it a different form of medical service … (1975)
Folder 20: [Untitled. Text begins:] Today we are going to look at a hypothesis (1975)
Folder 21: Some reflections on change in health service organizations (1976)
Folder 22: Prospective reimbursement and MAXICAP: the Rochester experiment (1977)
Folder 23: The transition of health care financing in the United States (1977)
Folder 24: Health care financing and control: the current dilemma in the United States (1978)
Folder 25: The Hospital reconsidered: ambulatory care (1978)
Folder 26: [Untitled. Text begins:] Dr. Shinnick, distinguished guests, colleagues and friends: We gather here today for a most salutary purpose, the dedication of a new hospital (1978)
Folder 27: [Untitled. Text begins:] Rural health care is as diverse in issues as most contemporary American problems (1978)
Folder 28: The health maintenance organization policy: a pilgrim’s progress (1979)
Folder 29: Holistic medicine (1979)
Folder 30: International escalation in health care expenditures (1979)
Folder 31: The HMO, the Sinai, and the promised land (1980)
Folder 32: St. Lawrence University seminar (1981)
Folder 33: Some trends affecting the organization of health services (1982)
Folder 34: Regulation and competition (1983)
Folder 35: Remarks on Dave Stewart (1985)
Folder 36: Loran Commission, Toronto (1985)

BOX TWO – ORAL PRESENTATIONS

Folder 1: Competition and cooperation: the Rochester experience (1986)
Folder 2: History of the Kaiser Permanente Medical Care Program [oral history] (1986)
Folder 3: The Bassett and the HMO (1987)
Folder 4: An alternate approach to hospital cost control: the Rochester experiment (undated)
Folder 5: [Untitled. Text begins:] When looking ahead, it often appears useful to first look back and see from whence we have come (undated)
Folder 6: ASIM address (undated)
Folder 7: Brookings remarks (undated)
Folder 8: Denver address (undated)
Folder 9: [Undated. Title begins:] The purpose of Direction ’75 would appear to be to help us to point the way in which we are going (undated)
Folder 10: Equity and the mutualization of the cost of health services: some trends (undated)
Folder 11: Evaluation of the Montefiore Hospital medical group as to cost and efficiency (undated)
Folder 12: [Untitled. Text begins:] The title of this symposium “Factors promoting or inhibiting successful change in service organizations and their clients” becomes quite global when even pursued to a limited extent (undated)
Folder 13: A friend, leader & Prince (undated)
Folder 14: [empty]
Folder 15: [Untitled. Text begins:] The health care system in the United States has been described as being in a state of crisis (undated)
Folder 16: [empty]
Folder 17: The HMO medical group (undated)
Folder 18: [Untitled. Text begins:] In recent years, researchers of varied disciplines have investigated patterns of medical care behavior in American society (undated)
Folder 19: [Untitled. Text begins:] Interests in the medical group, its motivation and organization in relationship to a health maintenance organization is relatively new for most in the health care field (undated)
Folder 20: The institutional fabric: organization, incentives, and change (undated)
Folder 21: [Untitled. Text begins:] This morning we shall discuss a specific medical care program, the Kaiser Foundation Medical Care Plan in Portland, Oregon (undated)
Folder 22: MAXICAP project overview (undated)
Folder 23: The medical group (undated)
Folder 24: Medical group practice in the health maintenance organization (undated)
Folder 25: Medicare, medical practice, and the medical profession (undated)
Folder 26: New Orleans address (undated)
Folder 27: Notes for an address in New Orleans (undated)
Folder 28: [Untitled. Text begins:] An occasion that commemorates the 250th anniversary of a world famous institution inherently makes one reflect (undated)
Folder 29: Osijek paper (undated)
Folder 30: An overview of the changing structure of medical care (undated)
Folder 31: PSRO (undated)
Folder 32: Prospects for the organization of personal health services (undated)
Folder 33: Financing of health care and reimbursement (undated)
Folder 34: [empty]
Folder 35: [Untitled. Text begins:] The role of the department in relationship to the community (and this includes local, regional, state and national levels) is threefold (undated)
Folder 36: Some aspects of physician career choice for the HMO (undated)
Folder 37: [Untitled. Text begins:] Sweden is obviously a nation of great interest for contemporary Americans concerned with health and social welfare (undated)
Folder 38: [Untitled. Text begins:] That the costs of medical care are rising significantly more rapidly than the rate of inflation is not news (undated)
Folder 39: [Untitled. Text begins:]Today, well trained physicians have a wide choice of well rewarded career opportunities (undated)
Folder 40: Towards a more rational resource approach (undated)
Folder 41: Transition and the HMO (undated)
Folder 42: The transition in the organization and financing of American medical care (undated)
Folder 43: [Untitled. Text begins:] Why does Bess Kaiser Hospital and its subsidiary, Kaiser Foundation Research Institute, apply for support from the Public Health Service as a health services research center (undated)
Folder 44: [Untitled. Text begins:] First of all let me state my bias (undated)

BOX THREE – PUBLICATIONS

Folder 1: The association of primary neoplasm of the liver the hemochromatosis, New England j. med. (1942)
Folder 2: Impact of a reduced-charge drug benefit in a prepaid group practice plan, Public health reports (1966)
Folder 3: The objective measurement of the post-hospital needs of a known population, Amer. journal of public health (1966)
Folder 4: Ther development of a home health program within a comprehensive prepaid group practice plan, Inquiry (1967)
Folder 5: The delivery of medical care, Hospital tribune (1968)
Folder 6: Determinants of medical care utilization, Health services research (1968)
Folder 7: Alternative approaches within the prepaid group practice field, [chapter in:] Proceedings of a seminar on prepaid group practice health plans (1968)
Folder 8: Documentation of twenty years operation and growth of a prepaid group practice plan, Medical care (1968)
Folder 9: The integration of an OEO health program into a prepaid comprehensive group practice plan, [chapter in:] Proceedings 18th annual Group Health Institute (1968)
Folder 10: The integration of an OEO health program into a prepaid comprehensive group practice plan, American journal of public health (1968)
Folder 11: Statement of Dr. Ernest Saward, Medical Director of the Permanente Clinic … [testimony before U.S. Senate] (1968)
Folder 12: The organization and utilization of home-care and extended-care facility services in a prepaid comprehensive group practice plan, Medical care (1969)
Folder 13: The relevance of prepaid group practice to the effective delivery of health services. Washington, D.C., [1969?]
Folder 14: The role of the medical school in medical service to the community, New York University medical quarterly (1969)
Folder 15: The health crisis, the university and society: season, 1970, Medical review (1970)
Folder 16: Organization of medical practice, [chapter in:] International Federation of Voluntary Health Service Funds conference proceedings (1970)
Folder 17: The prepaid group practice proposal, [chapter in:] Alternatives for organizing personal health care delivery (1970)
Folder 18: [Statement in:] Proceedings of the workshop on delivery of health care (1970)
Folder 19: Pre-payment in the academic teaching center, [chapter in:] Health of the nation 4 (1971)
Folder 20: Some caveats for medical schools, [chapter in:] The Kaiser-Permanente Medical Care Program: a symposium (1971)
Folder 21: Some concepts of a health service organization, Tufts medical alumni bulletin (1971)
Folder 22: Some values inherent in an organized system of medical care, [chapter in:] Anglo-American conference on medical care (1971)
Folder 23: Critique of document prepared by GeoMet, Inc. [typescript] (1972)
Folder 24: [Statement in:] Health maintenance organizations (1972)
Folder 25: Health policy and the HMO, Milbank Memorial Fund quarterly (1972)
Folder 26: Home care and extended care in a comprehensive prepayment plan. Chicago, 1972.

BOX FOUR – PUBLICATIONS

Folder 1: The relationship between ambulatory care and medical education, [chapter in:] Milbank Memorial Fund seminar reports (1972)
Folder 2: National considerations, Journal of medical education (1973)
Folder 3: The organization of medical care, Scientific American (1973)
Folder 4: Fashioning the models for tomorrow’s medical practice, Modern medicine (1974)
Folder 5: [empty]
Folder 6: Some information descriptive of a successfully operating HMO. Washington, D.C., 1973
Folder 7: [empty]
Folder 8: Toward an American health policy [typescript] (1974)
Folder 9: The economic argument for HMOs, Hospital surgical staff (1975)
Folder 10: The effect on future physician requirements of an HMO policy after national health insurance, Journal of community health (1975)
Folder 11: Environment, location and styles of practice, Journal of the American Optometric Association (1975)
Folder 12: Physician education in the People’s Republic of China (1975)
Folder 13: The regionalization of personal health services. Edited by Ernest W. Saward. New York, 1975.
Folder 14: What the University’s trustees should know for the future, Rochester review (1975)
Folder 15: Medicare, medical practice, and the medical profession, Public health reports (1976)
Folder 16: The regionalization of personal health services. Edited by Ernest W. Saward. Revised edition. New York, 1976.
Folder 17: The role of professional standards review of organizations in the assessment of quality, Bull. of the New York Academy of Medicine (1976)
Folder 18: Institutional organization, incentives, and change, Daedalus (1977)
Folder 19: Wilson Day remarks (1977)

BOX FIVE – PUBLICATIONS

Folder 1: The role of the medical director in a group practice HMO, [chapter in:] Health maintenance organizations (1977?)
Folder 2: An alternate approach to hospital cost control: the Rochester project, Public health reports (1978)
Folder 3: The current emphasis on preventive medicine, Science (1978)
Folder 4: Public Health Service Hospitals Ad Hoc Advisory Committee final report (1978)
Folder 5: The current role of the hospital in ambulatory care, Bull. of the New York Academy of Medicine (1979)
Folder 6: Health care financing and control [typescript] (1979?)
Folder 7: The demise of an individual practice association: a case study of Health Watch, Inquiry (1980)
Folder 8: El énfasis actual de la medicina preventiva, Salud mental (1980)
Folder 9: Health maintenance organizations, Scientific American (1980)
Folder 10: [empty]
Folder 11: Reflections on the history of prepaid group practice, [chapter in:] The challenge of the next ten years for health maintenance organizations (1980)
Folder 12: [empty]
Folder 13: Prepaid group practice: where is it now?, Chicago medicine (1980)
Folder 14: Book review of Harold Luft’s Health maintenance organizations, Inquiry (1981)
Folder 15: A consideration of mating rites: the HMO and the AMC, [chapter in:] Health maintenance organizations and academic medical centers (1981)
Folder 16: Health status, medical care utilization and cost experience of prepaid group practice and fee-for-service populations, Group health journal (1981)
Folder 17: International escalation of health care expenditures, [chapter in:] Getting better: a report on health care from the Salzburg Seminar (1981)

BOX SIX – PUBLICATIONS

Folder 1: Survey findings of health education in health maintenance organizations, Health educ. quarterly (1981)
Folder 2: Competition, profit and the HMO, New England j. of med. (1982)
Folder 3: Hospital cost containment in Rochester: from MAXICAP to the Hospital Experimental Payments Program, Inquiry (1982)
Folder 4: Reflections on change in medical practice, JAMA (1983)
Folder 5: Medical care: Main Street to Wall Street, [chapter in:] Medical and health annual (1984?)
Folder 6: Some trends affecting the organization of health services, Health matrix (1984)
Folder 7: Gresham’s law and managed care, HMO practice (1987)
Folder 8: Institutional organization: can the U.S. health system change?, Health issues (undated)
Folder 9: The organization of medical care, [publication undetermined] (undated)
Folder 10: Some considerations for cost control in voluntary health insurance [typescript] (undated)
Folder 11: Some views of the current dilemma of American medicine, [chapter in undetermined monograph] (undated)

BOX SEVEN – CORRESPONDENCE, ETC.

Folder 1: Correspondence (1977-80)
Folder 2: Correspondence (1981)
Folder 3: Correspondence (1982)
Folder 4: Correspondence (Jan-Jul 1983)
Folder 5: Correspondence (Aug-Dec 1983)
Folder 6: Correspondence (Jan-Apr 1984)
Folder 7: Correspondence (May-Dec 1984)
Folder 8: Correspondence (1985-1986)
Folder 9: Curriculum vitae of EWS
Folder 10: Memorial service (1989)

BOX EIGHT - CALENDARS

1970-1986

BOX NINE

Three dimensional awards

BOX TEN

Diplomas, certificates and awards