LEADER 07995nam 2200877 a 450 001 9910957625303321 005 20251017110059.0 010 $a9786610191772 010 $a9780309175074 010 $a0309175070 010 $a9781280191770 010 $a1280191775 010 $a9780309596749 010 $a0309596742 010 $a9780585085388 010 $a0585085382 035 $a(CKB)110986584751958 035 $a(OCoLC)43475712 035 $a(CaPaEBR)ebrary10057000 035 $a(SSID)ssj0000119841 035 $a(PQKBManifestationID)11143398 035 $a(PQKBTitleCode)TC0000119841 035 $a(PQKBWorkID)10073925 035 $a(PQKB)10848717 035 $a(MiAaPQ)EBC3376723 035 $a(Au-PeEL)EBL3376723 035 $a(CaPaEBR)ebr10057000 035 $a(CaONFJC)MIL19177 035 $a(OCoLC)923265664 035 $a(Perlego)4735442 035 $a(DNLM)823936 035 $a(BIP)47346446 035 $a(EXLCZ)99110986584751958 100 $a19970117d1996 uy 0 101 0 $aeng 135 $aurcn||||||||| 181 $ctxt 182 $cc 183 $acr 200 10$aChanging health care systems and rheumatic disease /$fCommittee on Changing Health Care Systems and Rheumatic Disease, Division of Health Care Services, Institute of Medicine, Frederick J. Manning and Jeremiah A. Barondess, editors 205 $a1st ed. 210 $aWashington, D.C. $cNational Academy Press$d1996 215 $a1 online resource (252 p.) 300 $aBibliographic Level Mode of Issuance: Monograph 311 08$a9780309056830 311 08$a0309056837 320 $aIncludes bibliographical references. 327 $aChanging Health Care Systems and Rheumatic Disease -- Copyright -- Preface -- Contents -- 1 Introduction -- CHANGING HEALTH CARE SYSTEMS -- CHRONIC DISEASE -- RHEUMATIC DISEASE -- PRACTICES AND ACHIEVEMENTS OF MANAGED CARE SYSTEMS -- Hospital Use -- Physician Use -- Tests and Procedures -- Home Health and Skilled Nursing Care -- Social/Health Maintenance Organizations -- WORK FORCE ISSUES -- RESEARCH, EDUCATION, AND TRAINING -- THE WORKSHOP -- 2 Opening Remarks -- 3 Keynote Address -- CHANGING HEALTH CARE -- HOSPITALS -- MANAGED CARE -- PHYSICIAN PAYMENT -- SPECIALIST-GENERALIST INTERACTION -- POLICY ISSUES -- 4 What Would Ideal Care Look Like? -- INTRODUCTION -- INVITED ADDRESS -- INVITED REACTION -- INVITED REACTION -- INVITED REACTION -- The Patient -- The Role of The Physician and the Relationship Between the Primary Care Provider and the Specialist -- Other Elements in An Ideal System of Care -- Rehabilitation -- Exercise -- Nonrestrictive Drug Formularies -- Alternative Delivery Mechanisms -- Structured Care -- Relationship Between Financing and Care -- Measurement of Outcomes in an Ideal Care System -- Access to an Ideal Care System -- Conclusion -- DISCUSSION -- 5 Managed Care and Rheumatoid Arthritis: Utilization and Outcomes Over 11 Years -- INTRODUCTION -- INVITED ADDRESS -- Literature on Health Care Utilization and Outcomes in FFS and HMOs -- Study Design -- Results -- Health Care Utilization -- Health Outcomes -- Summary of FFS-PGP Comparisons -- Comparisons of Care Provided by Rheumatologists and Nonrheumatologists -- Conclusions -- INVITED REACTION -- INVITED REACTION -- DISCUSSION -- 6 Measuring Medical Outcomes: Longitudinal Data on the Differential Impact of Health Care Systems on Chronic Disease -- INTRODUCTION -- INVITED ADDRESS -- INVITED REACTION -- INVITED REACTION -- DISCUSSION. 327 $a7 Changing Health Care Systems and Access to Care for the Chronically Ill -- INTRODUCTION -- INVITED ADDRESS -- The Chronically Ill: Promises and Risks in An Era of Managed Care and Competitive Markets -- Chronic Illness -- Risk and Current Managed Care Market Dynamics -- Capitation: Moving to the Provider Level? -- Standards of Comparison -- Inadequately Insured Chronically Ill: A Harsher Future -- Vulnerable Populations -- Policy Implications -- INVITED REACTION -- INVITED REACTION -- DISCUSSION -- 8 Training and Utilization of Generalists and Subspecialists at the University of California, Los Angeles -- INTRODUCTION -- INVITED ADDRESS -- Primary Care Physicians -- Subspecialty and Specialty Consultation -- Transportation Systems -- Education Systems -- Graduate Medical Education -- Integrating Subspecialty Medicine Into General Internal Medicine -- Continuing Medical Education -- INVITED REACTION -- INVITED REACTION -- DISCUSSION -- 9 How Easily Do Health Care Systems Adopt New Knowledge, and What Are the Likely Future Developments? -- INTRODUCTION -- INVITED ADDRESS -- INVITED REACTION -- INVITED REACTION -- DISCUSSION -- 10 Issues and Insights Regarding Research, Education, and Training -- INTRODUCTION -- INVITED ADDRESS -- Research -- Education -- Training -- Conclusion -- INVITED REACTION -- DISCUSSION -- 11 Commentary on the Day's Papers -- 12 Conclusions and Recommendations -- CONCLUSION 1 -- CONCLUSION 2 -- CONCLUSION 3 -- CONCLUSION 4 -- CONCLUSION 5 -- CONCLUSION 6 -- CONCLUSION 7 -- CONCLUSION 8 -- CONCLUSION 9 -- A FINAL NOTE -- Appendix A Biographies of Committee Members and Speakers -- Appendix B Workshop Guests. 330 $aMarket forces are driving a radical restructuring of health care delivery in the United States. At the same time, more and more people are living comparatively long lives with a variety of severe chronic health conditions. Many such people are concerned about the trend toward the creation of managed care systems because their need for frequent, often complex, medical services conflicts with managed care's desires to contain costs. The fear is that people with serious chronic disorders will be excluded from or underserved by the integrated health care delivery networks now emerging. Responding to a request from the National Institute of Arthritis and Musculoskeletal and Skin Diseases, this book reflects the results of a workshop that focused on the following questions: Does the model of managed care or an integrated delivery system influence the types of interventions provided to patients with chronic conditions and the clinical and health status outcomes resulting from those interventions? If so, are these effects quantitatively and clinically significant, as compared to the effects that other variables (e.g., income, education, ethnicity) have on patient outcomes? If the type of health care delivery system appears to be related to patient care and outcomes, can specific organizational, financial, or other variables be identified that account for the relationships? If not, what type of research should be pursued to provide the information needed about the relationship between types of health care systems and the processes and outcomes of care provided to people with serious chronic conditions? 517 1 $aChanging health care systems & rheumatic disease 606 $aRheumatoid arthritis$zUnited States 606 $aSystemic lupus erythematosus$zUnited States 606 $aManaged care plans (Medical care)$zUnited States 606 $aOutcome assessment (Medical care)$zUnited States 606 $aChronic diseases$zUnited States 606 $aHealth care reform$zUnited States 606 $aMedical care$zUnited States 615 0$aRheumatoid arthritis 615 0$aSystemic lupus erythematosus 615 0$aManaged care plans (Medical care) 615 0$aOutcome assessment (Medical care) 615 0$aChronic diseases 615 0$aHealth care reform 615 0$aMedical care 676 $a362.1/967227/00973 701 $aManning$b Frederick J$01806438 701 $aBarondess$b Jeremiah A.$f1924-$0101483 712 02$aInstitute of Medicine (U.S.).$bDivision of Health Care Services. 801 0$bMiAaPQ 801 1$bMiAaPQ 801 2$bMiAaPQ 906 $aBOOK 912 $a9910957625303321 996 $aChanging health care systems and rheumatic disease$94356025 997 $aUNINA