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This paper uses an institutional perspective (Scott, 1994; 2001; DiMaggio and Powell, 1991) to analyze the history and current state of the American health care field in terms of the alignment of its normative, cognitive, and regulatory elements. I depict the relation between institutional elements in each of three historical eras of the health care field (Scott et al 2000): the era of professional dominance (1945-1965), the era of federal involvement (1966-1982), and the era of managerial control and market mechanisms (after 1983 to the present). I argue that a weakening of alignment between these elements, beginning in the 1970s and increasing in the 1980s, led to consumer and provider dissatisfaction with managed care, and that the state of the field in the beginning of the 21st century suggests that a new era is emerging with renewed alignment between normative beliefs and values, cognitive models, and regulation. Implications for the future of health care and institutional theory are discussed. [ABSTRACT FROM AUTHOR]

The context for contemporary research and policy is set through a theoretically informed history of the modern American health care system that draws on the concept of countervailing powers and Fligstein's theory of control In this context, the papers of this special issue are then introduced. [ABSTRACT FROM AUTHOR]

The most important problem regarding health service utilization in Third World countries is that established indigenous forms of health care are readily available and compete with modern health care. Thus, in addition to understanding the components of the decision to seek medical help, we must understand the conditions that affect the choice of a specific health care system. This study examines the impact of medical pluralism on the use of modern forms of health care in Nepal. The findings show that the presence of medical pluralism is a significant factor which delays use of modern health services. Policy implications are discussed, and the need for more research in this area is stressed. [ABSTRACT FROM AUTHOR]

The concept of care, integral to medical sociology and to the sociology of health and illness, suggests new challenges in two key areas of this field: 1) within professional socialization, an examination of socialization to ethical thinking, behavior, and identity among professional caregivers, building on the substantial literature already accumulated; 2) in the arena of hidden or informal care providers, an analysis of male and female informal providers and the productive work, other than care, done by these individuals. In both analyses, as well as in all medical sociology and sociology of health and illness, gender, race, and class require more attention. Both analytic endeavors influence the substance and the contours of the field. [ABSTRACT FROM AUTHOR]

Although a number of policy-makers have suggested that previous experiences with medical care affect subsequent use of physician services, few researchers have examined the issue empirically. We divide the determinants of revisiting the doctor in pediatric practice into three categories: client characteristics, organizational characteristics, and characteristics of the doctor-client interaction; and we develop a causal model. Although race, income, and education have no direct effects on the frequency of returning to the doctor, they have indirect effects through the organization of health care and experiences within the health care system. Clients who are poorly educated tend to have consistently negative experiences with the health care delivery system. These experiences affect subsequent use of services. Positive experiences with the interpersonal, psychosocial aspects of the doctor-client interaction increase a client's proclivity to return to the doctor, while negative doctor-client interactions decrease the probability of returning to the doctor. [ABSTRACT FROM AUTHOR]

The development of a standardized instrument designed to measure the treatment environment of the mental hospital provided the basis for two separate works of Jay Jackson (1964, 1969). The present study is in part a partial re-analysis of this standardized instrument known as the "Characteristics of the Treatment Environment Scale" (CTE Scale). The analysis is based on a heterogeneous national sample of 18 state mental hospitals and results in the construction of a new instrument called the "Treatment Milieu Scales" (TMS). This present analysis includes shortening of the Jackson CTE instrument, the development of new factors, and a test of their predictive ability with respect to the therapeutic orientation of the treatment environment as measured by hospital effectiveness. These effectiveness measures include in-hospital indicators such as staff morale, quality of over-all care, psychiatric care, patient movement, and net release, as well as in-community measures including social adjustment, and medical (mental status) adjustment. Significant findings are obtained for the patient movement measures, while several partial correlations were found to be significant in all the other in-hospital measures except staff morale. The findings suggest the "humanistic" tradition of therapy is not necessarily the most appropriate when viewed from the perspective of in-community patient rehabilitation. [ABSTRACT FROM AUTHOR]