This text deals with issues of growing importance in both the US health care system and health care systems across the world. Such systems need to respond to changes in technology within health care, shifting technologies not specific to health care, and changes in the way patients and physicians view health and the use of health services in society. Chapters focus on how technologies and programs apply to either general groups within the health care system or more specialized groups, such as people with a certain health care problem. Papers deal with a variety of topics, from a focus on consumers and the varying roles the play in the emerging and changing US health care system, to the examination of specific principles such as social network approaches.
Part 1 Changing consumer perspectives in today's health care environment: managed care - the changing environment for consumers and health care providers; on being a proactive health care consumer - making an "unresponsive" system work for you; consumer desire and medical practice; using social network principles to structure linkages between providers and patients. Part 2 Specific technologies and programs: hospital technology-environment interplay as determinants of mortality; the history of nursing home bed supply in Chicago - the effect of federal policy and urban settlement on utilization; computer tools and shared decision making - patient perspectives of "knowledge coupling" in primary care. Part 3 Technology and providers: predictors of continued use of telemedicine by primary care professionals, medical specialists and patients; managing mental illness - trends in continuing mental health education for family doctors, 1977-1996. Part 4 Issues of changes for specialized patients - people with serious illnesses: using action research to improve collaboration between breast cancer patients and physicians - creating the programme for collaborative care; health determinants among persons with traumatic injuries - a comparative analysis using the sickness impact profile; the extended self - illness experiences of older married arthritis sufferers.