Changing 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.

7 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.