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This paper reviews the author's experience in becoming a medical sociologist before the field had become formalized. The contributions to medical sociology of sociologist Selden D. Bacon and physician and medical educator William R. Willard are described. The relationship of medical sociology to medical behavioral science, as experienced at the University of Kentucky, is discussed. Finally, the thesis of the author's 1957 paper on the nature and status of medical sociology is re-examined. [ABSTRACT FROM AUTHOR]

Over the last 25 years, national Health Maintenance Organization (HMO) and hospital firms attempted to enter local markets, either by acquiring formerly independent, locally based HMOs and hospitals or by directly entering local markets. While national HMOs have been relatively successful, national hospital firms have had much less success. This paper explores the reasons for this difference. It reviews changes in presence of national HMO and hospital firms in markets, discusses common conceptual lenses through which national entry into local markets typically has been viewed, and shows how social network theory can be used to develop a better understanding of why the entry experience of national HMO and hospital firms varies across markets. The paper concludes with a research agenda that addresses issues raised by social network theory and its application to national firm entry into local markets. [ABSTRACT FROM AUTHOR]

Emphasis on rural health problems has led to a relative neglect of urban health issues in developing societies. Yet the fact that a large proportion of the limited financial and human resources is allocated to urban health care makes it imperative for researchers and health planners to evaluate the effectiveness of the urban health care system. This paper examines data on health care utilization from a sample survey of 1500 households conducted in three areas of Accra, Ghana in 1982. The factors that influence the use of three types of health care services (clinics, drug vendors, and traditional healers) are examined. Suggestions are made for increasing the effectiveness of the health care system in Accra, with the aim of making medical care more accessible to all families. [ABSTRACT FROM AUTHOR]

This paper evaluates and describes methods for making psychiatric distinctions. It is by means of psychiatric distinctions that individuals are labeled mentally ill or mentally well. Within the mentally ill category, patients are differentially placed according to the severity and type of their mental illness. The placement of individuals into psychiatric categories is an essential prerequisite not only to the clinical treatment of patients but also to any research where the objective is to determine empirical regularities associated with mental illness. Until the patient is categorized, the practitioner has no logical guide for how to perform treatment or even whether he should treat the patient—i.e, the patient may not be a patient. Similarly, unless the psychiatric researcher has categorized his subjects according to some notion of mental illness he has no way of making comparisons or of assessing change, the two essential processes in research. Thus, the logical first step for arty discovery of new knowledge in the field of mental illness is to appraise the reliability and validity of methods for making psychiatric distinctions. No research findings can be more reliable or valid than the psychiatric distinctions used in carrying oat the research. [ABSTRACT FROM AUTHOR]

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]

Over the past decade, different parties in the health care field have developed and disseminated clinical practice guidelines as part of evidence-based medicine. These formal tools based on a scientific evaluation of the research literature purport to tell health care professionals how to practice medicine. Because clinical practice guidelines shift the knowledge base in the health care field through standardization, they remain con troversial within and outside medicine. In this paper, we evaluate the predictive accuracy of four medical professionalization theories-functionalism, Freidson's theory of professional dominance, deprofessionalization theory, and the theory of countervailing powers- to account for (1) the shift from pathophysiology to epidemiology with guidelines, (2) the creation of practice guidelines, and (3) the effects of clinical practice guidelines on the autonomy of health professionals. In light of the mixed predictive record of professionalization theories, we conclude with a need for "evidence-based sociology" and a recalibration of basic premises underlying professionalization theories. [ABSTRACT FROM AUTHOR]

The United States is the only western industrialized nation that fails to provide universal coverage and the only nation where health care for the majority of the population is financed by for-profit, minimally regulated private insurance companies. These arrangements leave one-sixth of the population uninsured at any given time, and they leave others at risk of losing insurance as a result of normal lVe course events. Political theorists of the welfare state usually attribute the failure of national health insurance in the United States to broader forces of American political development, but they ignore the distinctive character of the health care financing arrangements that do exist Medical sociologists emphasize the way that physicians parlayed their professional expertise into legal, institutional, and economic power but not the way this power was asserted in the political arena. This paper proposes a theory of stakeholder mobilization as the primary obstacle to national health insurance. The evidence supports the argument that powerful stakeholder groups, first the American Medical Association, then organizations of insurance companies and employer groups, have been able to defeat every effort to enact national health insurance across an entire century because they had superior resources and an organizational structure that closely mirrored the federated arrangements of the American state. The exception occurred when the AFL-CIO, with its national leadership, state federations and union locals, mobilized on behalf of Medicare. [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]

This paper examines the causal model which recent research suggests as a framework for research in health service utilization. Data from the 1971, 1972 and 1973 Health Interview Surveys are used to determine the effects of the predisposing, enabling, and illness-morbidity characteristics on several measures of health service utilization. Standardized regression coefficients show these characteristics to be substantively unrelated to health service utilization. The implications of these findings for existing theories of health service utilization are discussed. [ABSTRACT FROM AUTHOR]

This paper investigates the relationship between attributes of thirty-two innovative health services and their level of implementation in a national sample of hospitals and health departments. It was found that services implemented in hospitals are primarily characterized by high payoff, a low rate of cost recovery, and low social approval. For health department services perceived primarily as having high divisibility, a high association with the preventive orientation of the department, and a relatively low payoff had a high level of implementation. The respective attribute patterns accounted for 58 per cent of the variance in the implementation of health services in hospitals and 50 per cent of the variance in health departments. [ABSTRACT FROM AUTHOR]

Mental health costs of economic change are measured in a cross-level analysis that combines aggregate economic conditions (unemployment rate or absolute change in employment levels) with individual self-reports of undesirable job and financial events, psychosomatic symptoms, and help-seeking for emotional problems. The data were collected in Los Angeles County during 1978-80 in 12 quarterly surveys. Data for 4,144 Anglo respondents are analyzed in seven-way contingency tables to test two competing classes of explanations of the reported association between economic change and the use of mental health facilities. One class assumes that economic contraction affects utilization by increasing the incidence of disorder. The other class assumes that economic change affects utilization without increasing the incidence of disorder, but by influencing the decision to seek help for chronic or anticipated disorder. The results support versions of both classes of explanations. The support, however, is qualified by several factors that suggest that the widely-cited association between the economy and mental health is more complex than usually portrayed. [ABSTRACT FROM AUTHOR]

The present study examines the relationship between stress and the utilization of health services. Utilizing a prospective diary method with a random sample of 96 female users of a neighborhood health center, bivariate analysis indicate that the presence of stress on a given day is associated with an approximate doubling of the probability of a health care contact on that day. When controls are introduced into these analyses for a variety of background characteristics of these families, the daily stress/utilization relationship persists, independently of reported symptoms. In addition, a measure of stressful life events reported prior to the diary period also predicts utilization independently of both the daily stresses and reported symptoms; the stressful life-events variable in fact is one of the best single predictors of utilization. The diary data are also aggregated to approximate a retrospective research design, and substantial evidence of aggregation bias is found. [ABSTRACT FROM AUTHOR]

The editor, in this article, presents his views on various issues related to health and social behavior. The editor argues that according to figures provided by the previous two editors of the "Journal of Health and Social Behavior," (JHSB) this journal has had and continues to have an impact just under the "American Sociological Review" and the "American Journal of Sociology. " In fact, JHSB's impact factor has been almost double that of "Social Forces" for a number of years. The editor promises to continue the outstanding work of prior JHSB editors in selecting and publishing high quality, theory-driven, empirical papers across a wide range of topics in health and illness, the sociology of medicine, and the organization of medical care. JHSB is the journal. In the editor's view , a good editor, with the help of the editorial board and a bevy of careful reviewers, publishes the very best papers that are submitted for consideration and trusts that these reflect the cutting edge of the field.

A central sociological premise is that health care systems are organizations that are embedded within larger institutions, which have been shaped by historical precedents and operate within a specific cultural context. Although bound by policy legacies, embedded constituencies, and path dependent processes, health care systems are not rigid, static, and impervious to change. The success of health care reform in 2010 has shown that existing regimes do have the capacity to respond to new needs in ways that transcend their institutional and ideological limits. For the United States the question is how health care reform will reconfigure the existing network of public and private benefits and the power relationships between the numerous constituencies surrounding them. This article considers how institutions, interest groups, and ideology have affected the organization of the health care system in the United States as well as in other nations. It then discusses issues for future research in the aftermath of the 2009-10 health care reform debate. [ABSTRACT FROM PUBLISHER]

Many studies of innovation adoption in health care organizations focus either on organizational characteristics or the institutional environment, but not both. Furthermore, these perspectives are rarely employed simultaneously in both public and private health care organizations. This research considers the public-private distinction, organizational compatibility, and interorganizational referral relationships in the use of selective serotonin reuptake inhibitors (SSRIs) by substance abuse treatment organizations. Using data from nationally representative samples of 363 publicly funded and 403 privately funded substance abuse treatment centers, a four-category typology of public and private organizations initially predicted variation in SSRI use. However some differences were no longer significant once organizational and environmental characteristics were added to the statistical model. These data support hypotheses about the associations between organizational characteristics and SSRI use as well as hypotheses regarding the external environment. Future research should continue to integrate both internal and external factors in theoretical explanations of innovation adoption. [ABSTRACT FROM AUTHOR]

This article examines black Americans' preference for black health care providers. Using data from a national survey, we assess how blacks 'perceptions of discrimination are related to preference for same-race health care providers. Overall, the belief that discrimination is frequent in different-race doctor-patient dyads is associated with greater preference for a same-race provider However; the belief that discrimination occurs regardless of a doctor's race reduces preference for a same-race provider Finally, general perceptions of discrimination are distinct from concerns about personally being treated unfairly, and low personal concern about unfair treatment reduces preference for a same-race provider among those who believe that interpersonal discrimination occurs frequently. These results suggest a complex picture of how perceptions of discrimination influence preferred race of health care provider among blacks in the United States. [ABSTRACT FROM AUTHOR]

We hypothesize that divorce immediately increases psychological distress and has long-term negative consequences for the physical health of divorced people. In addition, we hypothesize that divorce indirectly causes long-term increases in distress through stressful midlife events. The hypotheses are tested using data from 416 rural Iowa women who were interviewed repeatedly in the early 1990s when they were mothers of adolescent children; the women were interviewed again in 2001. The data support the hypotheses. In the years immediately after their divorce (1991-1994), divorced women reported significantly higher levels ofpsychological distress than married women but no differences in physical illness. A decade later (in 2001), the divorced women reported significantly higher levels of illness, even after controlling for age, remarriage, education, income, and prior health. Compared to their married counterparts, divorced women reported higher levels of stressful life events between 1994 and 2000, which led to higher levels of depressive symptoms in 2001. [ABSTRACT FROM AUTHOR]

This article proposes a theory of physician-hospital integration The theory is developed by building on three streams of scholarship: "new" institutionalism, "old" institutionalism, and the theory of economic markets. The theory uses several key concepts from these theoretical frameworks, including the notions of environmental demands for legitimacy, market demands for efficiency, and agency. To enhance the predictive power of the theory, two new concepts are introduced: directionality of influence between institutional and market forces at the macro-societal level, and degree of separation of institutional and market domains at the local level-which add important predictive power to the theory. Using these concepts, a number of hypotheses are proposed regarding the ideal types of physician-hospital arrangements that are likely to emerge under different combinations of directionality of influence and institutional and market domain separation. Moreover the theory generates hypotheses regarding organizational dynamics associated with physician-hospital integration, including the conditions associated with high and low prevalence of physician-hospital integration, the extent to which the integrated organization is physiciancentric or hospital-centric, and whether physician-hospital integration is likely to be based on loose contractual arrangements or tight, ownership-based arrangements. [ABSTRACT FROM AUTHOR]

The managed care backlash is analyzed as a collective behavioral response led by attacks from threatened professional, provider, and special interest communities. Central to the backlash was the middle class `s repudiation of explicit rationing at the point of service adopted by Health Maintenance Organizations (HMOs) and other managed care plans. Americans are accustomed to choice and autonomy in their health care utilization and reacted negatively to restrictions. Assisted by negative anecdotes in the media and allegations of the denial of needed services, opponents built a negative picture of managed care often inconsistent with the empirical evidence. They succeeded in arousing public anxiety that appropriate health care might not be available when people most needed it. The private centralization of large health plans made them an easy target for the media, politicians, and provider groups in opposition. These attacks and regulatory initiatives succeeded in diluting strong utilization management controls contributing to current difficulties of containing large health cost increases. [ABSTRACT FROM AUTHOR]

Despite the lack of confidence in government agencies to operate a nationalized health-care system in the United States, government agencies have significantly influenced the distribution and financing of health-care services in the market. Using the State of Florida as a case study, we examine the conditions under which a state health-care agency can consistently influence health-care market arrangements. We examined records from Florida's legislative sessions between 1965 and 1993 focusing on 27 legislative initiatives to involve the state's healthcare agencies in the health-care services market. Using Boolean qualitative comparative analysis (QCA), we examined the conditions that facilitated or inhibited legislative policy initiatives for state action in Florida's health-care services market. The cohesiveness of state administrative agency and legislative leadership is of primary importance. Fragmented interests among health-care providers and fiscally legitimate policy positions, whether those of state agencies or health-care providers, are important enabling factors for state action. [ABSTRACT FROM AUTHOR]

The organization and delivery of health care in the United States is undergoing significant social, organizational, economic, political, and cultural changes with important implications for the future of medicine as a profession. This essay will draw upon some of these changes and briefly review major sociological writings on the nature of medicine's professional status to examine the nature of professional dynamics in a changing environment. To this end, we focus on the nature of medical work and how this work impacts on and is impacted by medicine's own internal differentiation and the presence of contested domains at medicine's periphery. We trace this dynamic through a number of issues including the multidimensional nature of medical work, the role of elites in that work, and how changes in the terms and conditions of work can exert changes at medicine's technical core. We close with some thoughts on the relationship of public policy to medicine's professional status, the role health policy might take in shaping a new professional status, the role health policy might take in shaping a new professional ethnic for medicine, and the role sociologists might play in this process. [ABSTRACT FROM AUTHOR]

In an attempt to understand the social forces and the economic and political conditions under which new social policies emerge in developing countries, this study outlines factors affecting the introduction of the health insurance system in South Korea. The emergence of the South Korean health insurance system was influenced by changing labor needs of the industrial sector, increasing social expectations, external and international pressures, increasing medical costs, and class conflict. These pressures compelled the South Korean government to respond to demands for the introduction of new social welfare policies in the 1970s. In the case of South Korea, the new health insurance system resulted from the government's attempts to cope with political, economic, and social pressures rather than from an ideological commitment to the well-being of the population. The resulting insurance system was a way to maintain the social order and legitimacy of the regime, and a means to promote the health of groups important to defense or production. [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]

Socioeconomic, medical care, and public health contexts are examined in Peruvian communities for their relationship to infant mortality. A deviant case analysis is used to uncover characteristics important in the social structure of Peruvian communities. Results from fieldwork in two "deviant" communities suggest that economic diversity, income disparity, social class fluidity, and women's autonomy, along with refined measures of medical care and public health resources, are important in understanding differentials in mortality. Attention is drawn to the community context and to the interplay of socioeconomic determinants affecting infant mortality. [ABSTRACT FROM AUTHOR]

In this study we re-examine the issue of gender differences in the use of mental health services by asking (1) whether gender differences in use depend upon the specific services studied; and (2) whether statistical models which are aligned closely to help-seeking theory can explain such differences better than previously used approaches. Our analyses are drawn from two waves of data collected from a representative sample of 3,921 respondents of the Epidemiologic Catchment Area study at the Yale University site. Results indicate that although women are more likely than men to consult a physician in the general medical sector about mental health-related problems, there are no gender differences in use of the mental health specialty sector. The relationship between gender and use of the general medical sector for mental health problems also varies by psychiatric status and by attitudes toward mental health services. In the presence of a psychiatric disorder determined by the Diagnostic Interview Schedule, the likelihood of using services is highest for women with positive attitudes and for men with negative attitudes. [ABSTRACT FROM AUTHOR]

The differences in physical and social functioning between the elderly and the general population are likely to affect the utilization of social and health services we focus on two areas: (1) determining whether the elderly are affected by factors known to be important to service utilization among the general population; and (2) exploring the relationship between medical, mental health, personal care, and recreational services, and conceptually analogous factors. Results suggest that the elderly and the general population are similarly affected by need, enabling, and predisposing factors. Once need was taken into account, enabling and predisposing factors explained little variance in utilization of any services. With the exception of recreational services, both social and medical care service utilization can be explained by the same factors. [ABSTRACT FROM AUTHOR]

We developed and tested a model of client satisfaction with medical care in which sociodemographic characteristics of the physician affect client satisfaction under conditions of unmet expectations and a lack of choice. We hypothesized that in small fee-for-service practices such as solo practice, where the client chooses his or her physician, status characteristics of the doctor would be unrelated to client satisfaction. Conversely, in large prepaid group practices where the client is assigned a physician, nonnormative physician status characteristics would create lower client satisfaction. Because expectations are based on statistical norms, we hypothesized that clients in large prepaid multispecialty groups would be most satisfied with physicians who fit the norm-middle-aged white males from higher status Protestant or Jewish backgrounds. In a sample of pediatricians and their clients, we found our hypotheses to be strongly supported, with one modification-the relationship between client satisfaction and the physician's socioeconomic background is parabolic. Furthermore, the negative effect of non-normative physician religious status on client satisfaction in large prepaid groups is offset by the client-physician match and by experience with the physician. [ABSTRACT FROM AUTHOR]

Although previous research has shown that the structure of groups or clusters of hospitals depends upon environmental characteristics of local service areas, little work has been done to demonstrate the importance of specifying the appropriate environmental framework for hospital clusters of varying composition. Clusters composed of only community general hospitals are affected primarily by the characteristics of the local community or service area, whereas clusters composed of both community hospitals and tertiary care hospitals (such as teaching hospitals or Veterans' Administration Hospitals) must respond to both local contingencies and extra-local constraints, such as the regional demands for specialized care and the teaching and/or research activities of other tertiary care hospitals. Thus, the presence of a tertiary care facility within a hospital cluster may alter significantly the context of the cluster. Using longitudinal data on national samples of tertiary and nontertiary care settings, I tested several hypotheses concerning the structure and environmental responsiveness of community hospital clusters in these different contexts. [ABSTRACT FROM AUTHOR]

This research addresses measurement issues, derives a model of the effects of life events on mental health, and tests hypotheses regarding the role of social supports in modifying these effects over time. Analyses were based on a longitudinal study of persons (N = 2,234) sampled from a general population in Seattle, Washington, as part of Rand's Health Insurance Experiment. In addition to sociodemographic variables, measures of physical limitations, mental health, social supports, and stressful life events were fielded twice (one year apart), using previously validated measures. Data for a random half of the sample were analyzed to evaluate different approaches to defining and scoring life events and social supports and to fit a model of the main and interactive effects of these variables on mental health. The best-fitting model was then cross-validated, using the remaining half of the sample. Results support the following conclusions: (1) Social supports predict improvements in mental health over time, (2) life events and physical limitations predict a deterioration in mental health overtime, (3) the negative effects of life events and physical limitations on mental health do not vary according to amount of social support, and (4) differences in measurement strategies for life events and social supports produce some variance in results, but not in conclusions about whether effects on mental health are additive or interactive. [ABSTRACT FROM AUTHOR]

Much of the research on informal practice relationships among physicians is based upon observations of physicians in solo, fee-for-service forms of practice. This study examines informal relationships for physicians in group practice. Specifically, this study analyzes the within-hospital consulting patterns of physicians in two group practices, one fee-for-service and the other prepaid. Compared with the fee-for-service-group physicians, the prepaid-group physicians (1) engaged in less consulting, (2) utilized nongroup consultants to a greater degree, (3) relied more heavily on medical residents as consultants, and (4) achieved a lower degree of reciprocity in consulting exchange. Physicians in both of the groups exhibited a pattern of mutual avoidance in the choice of consulting partners. [ABSTRACT FROM AUTHOR]

One major assumption underlying much of the health-care policy in the United States is articulated and submitted to empirical test in this study. The test assesses the relative impacts of health service resources and community structure on two measures of physical health status. All constructs are measured by multiple indicators at three points in time: 1950, 1960, and 1970. The parameters of the conceptual model are estimated by multiple regression techniques. A block-recursive test of the static model shows that health resources exert minimal net impacts on health status. The impact of community structure on health status is more pronounced. Further, an examination of beta coefficients shows that the relationship between health service resources and physical health status is not consistent with the postulated notion of how the health system affects health. An evaluation of change data over the twenty-year period was consistent with the static model. Probationary policy implications of the findings are offered. [ABSTRACT FROM AUTHOR]

This study introduces a social indicator of access to medical care--the symptoms-response ratio-- that reflects the difference between the number of visits in response to symptoms that actually occur and the number that a panel of physicians indicate is appropriate for these same symptoms. Findings on the index fro a national sample of the United States population affirm differentials in access that are generally thought to exist in terms of other access indicators (conventional use measures, insurance coverage, etc.). Nonwhites, rural farm people, the poor, and those who have no usual place to go for medical care were found to have less access to care than would be judged appropriate, based on the symptoms-response index. The index also suggests possible "over-utilization" among certain groups such as children and people who see specialists as their regular source of care. [ABSTRACT FROM AUTHOR]

The rehabilitation system in the 1970's will be markedly different in its structure and activities from what it was in the past. The bases for this prediction are the current challenges to the traditional model of professional-client relationships; an increase in activity on the part of the client and his family in the rehabilitation process; a changing ideology and value system concerned with the right rather than the privilege of individuals to have good medical care and rehabilitation; and the high financial costs of institutional care of the disabled. A proposed solution is to develop for the rehabilitation system a "built-in environment." [ABSTRACT FROM AUTHOR]

Three investigations show that laymen presented with medical information recall best (a) what they are told first and (b) what they consider most important. The findings from volunteer subjects recalling fictitious information are confirmed with patients recalling real information. In the real-life situation, it was possible to manipulate recall of certain kinds of information by using the primacy and importance effects. [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]

Middle-aged and elderly individuals using health care facilities from new resources provided information on the interpersonal network they employed in reaching such decisions. Specifically, we examined factors affecting the networks employed, their composition, the quality of ties that characterized the interaction within networks, and the effect that such networks had on decisions reached. The findings modify and extend earlier inquiries that focus on lay-referral systems and personal-influence networks as these relate to decision making. [ABSTRACT FROM AUTHOR]

Hospital emergency services handle largely routine "walk-in" cases, the numbers of which are increasing rapidly. A classification of cases into self referrals, professional referrals, and contract cases is used to characterize the emergency department clientele in central urban public hospitals, voluntary teaching hospitals, proprietary hospitals without resident staffs, and to suggest the direction of future utilization. [ABSTRACT FROM AUTHOR]

A variety of explanations have been offered for the utilization of alternative types of medical therapy in the developing world. This study assesses these explanations in terms of the disposition of 520 illness episodes in a rural Malay village where five distinctive types of therapy are available. The perceived etiology of the disorder and the degree of functional impairment were found to be significantly associated with the selection of a therapeutic alternative. [ABSTRACT FROM AUTHOR]

Patterns of informal, verbal communication among staff of the medical and surgical services of the University Hospital and Clinics of the J. Hillis Miller Health Center were studied through observation of conversations between two or more persons. Results indicate that there was a significantly greater degree of lateral communication at this Health Center than was reported. Patterns of communication were not significantly different between the medical and surgical services. Conversations were typically frequent, brief, between two persons, and centered on the clerks of the floor. While the importance of effective communication among the medical and health-related professions is generally recognized, little has been written about informal oral communication in general hospitals. Written communications are used widely, but these are the least effective methods of producing understanding. The importance of oral communication to patient care is detailed.