Changing Health Care Systems and Rheumatic Disease

Market 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?

• Front Matter
• 1: Introduction
• 2: Opening Remarks
• 3: Keynote Address
• 4: What Would Ideal Care Look Like?
• 5: Managed Care and Rheumatiod Arthritis: Utilization and Outcomes Over 11 Years
• 6: Measuring Medical Outcomes: Longitudinal Data on the Differential Impact of Health Care Systems on Chronic Diseases
• 7: Changing Health Care Systems and Access to Care for the Chronically ill
• 8: Training and Utilization of Generalists and Subspecialists at the University of California, Los Angeles
• 9: How Easily Do Health Care Systems Adopt New Knowledge, and What Are the Likely Future Developments?
• 10: Issues and Insights Regarding Research, Education, and Training
• 11: Commentary on the Day's Papers
• 12: Conclusions and Recommendations
• Appendix A: Biographies of Committee Members and Speakers
• Appendix B: Workshop Guests