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Community decision-making is a critical ingredient in assuring that all segments of the population are included in care. The exact mix of public and private systems may vary from place to place, or in the same place over time, or at the same time for different segments of the population.

The interests of the care system may include altruism and enlightened self-interest (community visibility, potential market share).

From a public health perspective, the incentives to support personal care programming vary depending on the population threat posed by failure to assure care. That is, most health departments will provide treatment/care services for tuberculosis and sexually transmitted diseases, and the personal care service of immunizations. They have been less likely to provide care for chronic, non-communicable diseases of adults such as cancer or heart disease. An intermediate position is occupied by services associated with reproductive health, pregnancy and early childhood.