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Mitigating the impacts of Human Immunodeficiency Virus/Acquired Immune Deficiency Syndrome (HIV/AIDS) and substance use requires comprehensive and systematic thinking in designing interventions and developing policies. This study describes the growth of research publications from 1991 to 2021 in the Web of Science database and points out current research landscapes in the fields of HIV/AIDS and substance use. Latent Dirichlet Allocation was used for classifying 21 359 papers into corresponding topics. The most common topics were HIV transmission, HIV infection, quality of life and mental health of substance users, and the biomedical effect of substance use. Emerging research landscapes include vulnerabilities of people who inject drugs to HIV transmission and related health problems. This study found a lack of research on health services, interdisciplinary and inter-sectoral in combination with clinical evaluation and treatment services. Future investment and implementation of HIV/AIDS and substance use programs should focus on research of health services and clinical evaluation, especially context-specific interventions. [ABSTRACT FROM AUTHOR]

The article presents the author's views regarding complementary medicine which indicates approaches which are independent from modern scientific medicine, but work with such medicine in a broader context of health care delivery. The author says that it is necessary to promote an atmosphere of permissive legislation for the control and licensing of a broad spectrum of practitioners, if a consumer based health plan which includes complementary medicine is to be implemented.

The article focuses on the alteration in health care model for elderly people in Great Britain. The need for the change in treatment approach emerged due to diminishing younger workforce and rapidly growing number of elderly people. The effectiveness of all advances in care for the elderly is undermined by government policies and particularly due to the ways of spending money.

Introduction: Prior to the COVID-19 pandemic, telehealth utilization was growing slowly and steadily, although differentially across medical specialties in the United States. The pandemic dramatically expanded physician use of telehealth, but our understanding of how much telehealth use has changed in primary care in the United States, the correlates of physician telehealth uptake, and the frequency with which primary care physicians intend to use telehealth after the pandemic are unknown. This paper is designed to assess these important questions. Methods: Using data from an original national survey of 625 primary care physicians conducted from May 14 to May 25, 2021, we investigate the frequency of physician telehealth use before and during the pandemic and intended use after the pandemic. We also assess the correlates of changes in telehealth use by physicians, comparing telehealth use before the pandemic to use during and after the pandemic. Results: The proportion of primary care physicians using telehealth often, jumped from 5.3% (95% CI 3.5, 7.0) before the pandemic to 46.2% (95% CI 42.3, 50.2) during the pandemic. More importantly, over 70% of physicians intended to use telehealth at least occasionally after the pandemic compared to just 18.7% before, with younger physicians, physicians without telehealth training in medical school, and Asian physicians most likely to increase their telehealth use long-term. Discussion: The COVID-19 pandemic has spurred expansion in telehealth use by primary care physicians that will continue to shape care delivery well beyond the pandemic. Policy change could be needed to facilitate this growth of telehealth long-term. [ABSTRACT FROM AUTHOR]

To mitigate COVID-19 exposure risks in methadone clinics, the Substance Abuse and Mental Health Services Administration (SAMHSA) issued a temporary modification of regulations in March 2020 to permit, with state concurrence, extended take-home methadone doses. The modification allowed for up to 28 days of take-home methadone for stable patients and 14 days for those less stable. Using both interrupted time series and difference-in-differences methods, this study examined the association between the policy change and fatal methadone overdoses, comparing states that permitted the expansion of take-home doses with states that did not. The findings suggest the pandemic emergency take-home policy did not increase methadone-involved mortality. [ABSTRACT FROM AUTHOR]

The Press Ganey (PG) Outpatient Medical Practice Survey measures patients' experiences of healthcare access in the U.S. We aimed to identify differences in experiences of access to care by patient race, ethnicity, and other sociodemographic characteristics, an important first step in informing health policy and ensuring equitable healthcare delivery. We performed a cross-sectional analysis of PG surveys for adult outpatient visits within the University of Pennsylvania Health System from 2014–2017, including 119,373 unique patients. Compared with White patients, Black (odds ratio [OR] 0.84; 95% confidence interval [CI] 0.80–0.87), Asian (OR 0.62; 95% CI 0.58–0.66), and other/unknown race patients (OR 0.83; 95% CI 0.72–0.94) were each less likely to report the maximum score for timely access to care. Patients of all minoritized groups, as well as those whose primary language was not English, reported lower scores in secondary access measures related to communication and respect, compared to White and primarily English-speaking patients, respectively. Efforts to improve the experience of access to care among racial and ethnic minoritized patients are imperative to achieve equity in healthcare delivery. [ABSTRACT FROM AUTHOR]

The authors reflect on the performance of health in England, as published in the November 2004 White Paper of Great Britain's government. They stressed that most of the consumers wish to make their own health choices though they still need help in coping with harmful factors. They assessed that this paper differs from any previous document in proposing public health back to the public. They pointed out that the current emphasis on preventive targets boosts strong emotions among clinicians.

To conduct a systematic review and develop a conceptual framework on the mechanisms linking loneliness, social isolation, health outcomes and mortality. Electronic databases were systematically searched (PubMed, MEDLINE, Scopus and EMBASE) from inception to October 2018 followed by manual searching to identify research on loneliness, social isolation and mortality in adults published in the English language. Articles were assessed for quality and synthesised into a conceptual framework using meta-ethnographical approaches. A total of 122 articles were included. These collated observational designs examining mediators and moderations of the association in addition to qualitative studies exploring potential mechanisms were included. A framework incorporating 18 discrete factors implicated in the association between loneliness, social isolation and mortality was developed. Factors were categorised into societal or individual, and sub-categorised into biological, behavioural and psychological. These findings emphasise the complex multidirectional relationship between loneliness, social isolation and mortality. Our conceptual framework may allow development of more holistic interventions, targeting many of the interdependent factors that contribute to poor outcomes for lonely and socially isolated people. [ABSTRACT FROM AUTHOR]

Relationship management can be applied in a variety of fields, but there is perhaps no other field that could benefit more from the application of relationship management than public health. The achievements of public health in the United States over the last century are many, but its challenges are daunting. This paper begins with a review of the mission of public health and the status of public health in this nation, including an examination of the most significant public health challenges. I then describe the complex nature of the public health system and summarize the latest positive development in public health planning. Finally, I outline how relationship management can be implemented in order to help improve public health outcomes. [ABSTRACT FROM AUTHOR]

This paper examines the impact of changes in the medical marketplace on medicalization in U S. society. Using four cases (Viagra, Paxil, human growth hormone and in vitro fertilization), we focus on two aspects of the changing medical marketplace: the role of direct-to-consumer advertising of prescription drugs and the emergence of private medical markets. We demonstrate how consumers and pharmaceutical corporations contribute to medicalization, with physicians, insurance coverage, and changes in regulatory practices playing facilitating roles. In some cases, insurers attempt to counteract medicalization by restricting access. We distinguish mediated and private medical markets, each characterized by differing relationships with corporations, insurers, consumers, and physicians. In the changing medical environment, with medical markets as intervening factors, corporations and insurers are becoming more significant determinants in the medicalization process. [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]

This paper reviews various theoretical perspectives on organizational change which have been and could be applied to medical organizations. These perspectives are discussed as both filters influencing our observations (research) and mirrors of the shifting dynamics of delivery system reform (policy). We conclude with an examination of how such theories can provide useful insights into our rapidly changing health care system. [ABSTRACT FROM AUTHOR]

Background: Despite an increase in methamphetamine use and subsequent hospitalizations, the majority of Canadian hospitals currently lack harm reduction strategies for substance use. This can mean that people with lived experience of methamphetamine use are faced with a number of difficult decisions to make when admitted to hospital. Caring for people with lived experience of methamphetamine use can also be problematic with zero tolerance policies requiring abstinence to be maintained. This analysis set out to understand potential health care issues due to a lack of harm reduction strategies from the prospective of people with lived experience of methamphetamine use as well as health care/service professionals. Methods: Based on a larger study, this secondary analysis explored issues discussed by people with lived experience of methamphetamine use and health care/service professionals regarding the challenges of providing harm reduction approaches in the hospital setting. A total of 108 individuals with lived experience of methamphetamine use completed a qualitative component of a mixed-method interview. In addition, 31 health care/service professionals participated in virtual focus groups and one-to-one interviews. Responses were analyzed using an ethnographic thematic approach. Results: People with lived experience of methamphetamine use reported 3 choices upon admission: leave or avoid the hospital, stay but experience unsupported withdrawal, or stay but hide their substance usage from health care professionals. Health care/service professionals described 2 options: uphold zero tolerance that can lead to stigma and a lack of knowledge regarding addiction, or accept harm reduction but be unable to implement such strategies. This could lead to health being compromised due to policy and practice that requires abstinence. Neither group of participants described a good choice for them. Conclusion: Current policy and education related to substance use needs to be revised. [ABSTRACT FROM AUTHOR]

The purpose of this study was to describe policies developed by English-speaking Canadian health authorities to guide multi-disciplinary healthcare practice in the context of MAID. Seventeen policies from 9 provinces and 3 territories were identified and analyzed thematically. Themes developed from these documents related to ensuring a team approach to care, supporting informed patient choice, creating region-specific guidance on eligibility criteria and safeguards, accommodating conscientious objection, and making explicit organizational responsibilities. Ethical language concerned vulnerability, non-judgmental care, dignity, non-abandonment, confidentiality, moral conscience, and diverse cultural values. Overall, these policies addressed important risk mitigation strategies, acknowledged important social contracts, and supported ethical practice. Collectively, these policies outline important considerations in the evolving Canadian context for other jurisdictions seeking to create policy around assisted death. [ABSTRACT FROM AUTHOR]

Introduction: From the onset of the COVID-19 pandemic, public health officials have sought to develop evidence-based messages to reduce COVID-19 transmission by communicating key information to media outlets and the public. We describe the development of an interdisciplinary rapid message testing model to quickly create, test, and share messages with public health officials for use in health campaigns and policy briefings. Methods: An interdisciplinary research team from the University of North Carolina at Chapel Hill assembled in March 2020 to assist the state health department in developing evidence-based messages to influence social distancing behaviors in the state. We developed and iteratively executed a rapid message testing model; the components of the 4-step model were message creation, survey development, survey administration, and analysis and presentation to health department officials. The model was executed 4 times, each during a 7-day period in April and May, and each subsequent survey included new phrasing and/or messaging informed by the previous week's survey. A total of 917 adults from North Carolina participated in the 4 surveys. Results: Survey participants rated messages focused on protecting oneself and others higher than messages focused on norms and fear-based approaches. Pairing behaviors with motivations increased participants' desire to social distance across all themes and subgroups. For example, adding "Protect your grandmother, your neighbor with cancer, and your best friend with asthma," to messaging received a 0.9-point higher score than the base message, "Stay 6 feet apart from others when out in public." Practice Implications: Our model to promote social distancing in North Carolina during the COVID-19 pandemic can be used for rapid, iterative message testing during public health emergencies. [ABSTRACT FROM AUTHOR]

This paper describes the origins and development of the sociology of health and illness in Britain and shows that these were rooted in practical concerns, rather than deriving from sociological theory or general sociology. Medical practitioners and researchers, health administrators, patients and the feminist movement have been influences encouraging sociologists to turn their attention to health and illness. The present state of the sub-discipline is one of great activity, but little theoretical or methodological unity. The contribution to the subject of Parsons, Freidson and Mechanic, the marxists, the British post-Fabians, empiricists and phenomenologists are discussed, as is the contribution of the subdiscipline to health and health policy research. In considering the future of the subject, a sociology of health and illness rather than of medicine is proposed and the inevitable moral and political implications of sociological activity in this area are exposed. The need to face the implications of suffering for social relations in health care and the tendency to ignore these is discussed. The wide-ranging importance of the sociology of health and illness to general sociology is stressed and its potential contribution to health and health policy assessed [ABSTRACT FROM AUTHOR]

The article presents information on the issues related to the government policy for public health and the efficient production of hospital services. The promotion of consumer choice and the provision of information to the public are the main principles of the current government policy in Great Britain. The performance of hospital is manifested in the National Health Service.

The authors discuss the challenges in translating national and state reopening plans into local reopening policies during the COVID-19 pandemic. Topics mentioned include the reason why linear plans are easy to communicate, a plan confirmed in Indiana on April 29, 2020 to hire 500 contact tracers, and the U.S. Centers for Disease Control and Prevention's Public Health Associates Program.

The use of Internet-enabled technology (information and communication technology such as smartphone applications) may enrich information exchange among providers and, consequently, improve health care delivery. The purpose of this systematic review was to gain a greater understanding of the role that Internetenabled technology plays in enhancing communication among physicians. Studies were identified through a search in three electronic platforms: the Association for Computing Machinery Digital Library, ProQuest, and Web of Science. The search identified 5140 articles; of these, 21 met all inclusion criteria. In general, physicians were satisfied with Internet-enabled technology, but consensus was lacking regarding whether Internet-enabled technology improved efficiency or made a difference to clinical decision-making. Internetenabled technology can play an important role in enhancing communication among physicians, but the extent of that benefit is influenced by (1) the impact of Internet-enabled technology on existing work practices, (2) the availability of adequate resources, and (3) the nature of institutional elements, such as privacy legislation. [ABSTRACT FROM AUTHOR]

Patient-reported outcome data have moved from the realm of research to center stage in efforts to provide patient-centered care. In a Danish context, health authorities are seeking to promote and standardize the use of patient-reported outcome data. This involves normative articulations of what counts as meaningful data work in a healthcare system characterized by intensified data-sourcing. Based on ethnographic material, I suggest that an assemblage of actors, both human and technological, has accomplished the articulation of meaningful data work, with patient-reported outcome as being dependent on the active application of data in clinical trajectories--in contrast to supplying data "passively" for secondary use for research or governance. This normative articulation of "Active patient-reported outcome" legitimizes the Danish patient-reported outcome assemblage by showing alignment of the concerns of patients, clinicians and health authorities. At the same time, "Active patient-reported outcome" foreshadows challenges in making data work meaningful in local practice. [ABSTRACT FROM AUTHOR]

This article explores how datafication, as an increasing use of quantified performance data (e.g. performance indicators, rating sites), and social media are enacted in everyday healthcare practice. Drawing on the literature about the quantified self, this article shows that datafication evokes practices of gamification: the application of frames of play and rewards to the healthcare setting. We discern three (intermingling) practices of gamification: adapting, ignoring and changing. 'Adapting' refers to the incorporation of quantifying features in healthcare, while 'ignoring' sheds light on how practitioners seek to circumvent quantifying mechanisms. Change refers to how practitioners actually embrace quantifying mechanisms in order to extend (and improve) their work and to highlight their quantified professional self. We elucidate how datafication of healthcare 'opens up' and reconfigures established practices of organizing care and caring - not only for the patient but also to (re)craft the professional clinical identity. [ABSTRACT FROM AUTHOR]

Proper hand sanitation prevents spreading of many types of illness and infection, thereby lowering the quantitative and qualitative costs of public and private health care. Research shows that thinking or knowing someone is watching you wash your hands in a public lavatory appreciably improves the odds of you doing so. Nevertheless, most restaurants place their hand washing facilities inside the bathroom, beyond public view. Reformers from the public and private sectors should work cooperatively to incentivize restaurant owners voluntarily to place their hand washing facilities in public spaces. If this uncompelled approach proves unsuccessful, reformers should seek to impose laws requiring that all public eateries place their bathroom washbasins in conspicuous locations. The discussion closes by suggesting ancillary improvements to test in pursuit of further improving hand washing rates and practices in public spaces. [ABSTRACT FROM AUTHOR]

The article discusses the role of state-level politics and funding allocations for children's health insurance programs (CHIPs) in the U.S. The author cites factors for reduced CHIP spending including Republican power in state legislatures and governorships. The article lists aspects associated with greater CHIP spending such as professionalized state legislatures, strong state financial abilities, and states with a history of social policy innovation. The author presents theoretical arguments about social policy development including power resource theory, institutional arrangements, logic of industrialism, race, and ethnicity. Quantitative data is analyzed from the U.S. Centers for Medicare and Medicaid Services (CMS)'s Statistical Abstract of the United States from 1998 to 2008.

This article identifies and examines various types of the ombudsman institution that have evolved over the years, provides a clear and systematic classification of these models, and compares and contrasts them. Relatively recent developments can be better understood if they are also discussed in the light of the past. For this reason at the beginning of this article, the origin, development, and salient features of the original/classical model of the ombudsman institution are briefly discussed. Against this backdrop, the emerging pattern and the salient features of other types or deviant/distorted models of ombudsman offices are examined. [ABSTRACT FROM AUTHOR]

This article addresses the role of science and science advisory bodies in modeling practices for the support of policy-making procedures in the Netherlands in the field of health care. The authors show, based on a detailed investigation of a prestigious interdisciplinary modeling project in which an economic care model was developed for governmental use, that science advisory bodies are entangled with the policy actors they advise in what we call boundary configurations. Boundary configurations are strongly situated interconnections between science advisory institutes and policy institutions that share a specific approach to problem definitions and methods and that are embedded in (and at the same time embed) specific social, discursive, and material elements. Importantly, as the case study shows, such boundary configurations shape the kind of science, and related, the kind of social and political theories about the world, that is effectuated in modeling practices. In this case study, the boundary configuration in which economic experts and policy makers participated contributed to the articulation of health care in terms of a market-based policy program for the health care sector. [ABSTRACT FROM AUTHOR]

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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]

The Medicare Prescription Drug, Improvement, and Modernization Act of 2003 (MMA) provides a prescription drug benefit for Medicare-eligible seniors that includes access to medication therapy management services (MTMS) through pharmacists. We theorize that local community pharmacy market competition affects the decision of individual community pharmacies to provide MTMS. Our model suggests that MTMS services are more apt to be supplied in markets at the extremes of community pharmacy concentration (very low and very high). We found that local community pharmacy competition affected the service choices made by the pharmacy decision-makers willing to provide MTMS in a manner consistent with our theory. As a result, patient access to MTMS services depends on both (1) patient access to pharmacies willing to provide MTMS and (2) the level of local community pharmacy competition. [ABSTRACT FROM AUTHOR]

The article considers the place of minority ethnic health in the priorities of the British National Health Service (NHS). It identifies some of the NHS priorities, such as the promotion of health and the prevention and management of disease. The extent to which the NHS address the health needs of minority ethnic groups in the country is examined. It stresses the need for a balanced and considered approach to priority setting within the NHS.

In this article we analyze the corporate dominance of health care in the United States and the dynamics that have motivated the international expansion of multinational health care corporations, especially to Latin America. We identify the strategies, actions, and effects of multinational corporations in health care delivery and public health policies. Our methods have included systematic bibliographical research and in-depth interviews in the United States, Mexico, and Brazil. Influenced by public policy makers in the United States, such organizations as the World Bank, International Monetary Fund, and World Trade Organization have advocated policies that encourage reduction and privatization of health care and public health services previously provided in the public sector. Multinational managed care organizations have entered managed care markets in several Latin American count fries at the same time as they were withdrawing from managed care activities in Medicaid and Medicare within the United States. Corporate strategies have culminated in a marked expansion of corporations' access to social security and related public sector funds for the support of privatized health services. International financial institutions and multinational corporations have influenced reforms that, while favorable to corporate interests, have worsened access to needed services and have strained the remaining public sector institutions. A theoretical approach to these problems emphasizes the falling rate of profit as an economic motivation of corporate actions, silent reform, and the subordination of polity to economy. Praxis to address these problems involves opposition to policies that enhance corporate interests while reducing public sector services, as well as alternative models that emphasize a strengthened public sector [ABSTRACT FROM AUTHOR]

The article points out that tuberculosis (TB) care in Great Britain faces two major challenges. These are the lack of education in TB with Great Britain and the lack of resources for control worldwide. It is proposed that two chairs with a particular interest in clinical TB be created in Britain. At the international level, scarce funds could be shifted towards TB control.

Legislation, such as the federal Personal Responsibility and Work Opportunity Reconciliation Act (1996), the Balanced Budget Act of 1997, and the authorization of federally-funded health insurance coverage for children (State Children's Health Insurance or SCHIP) continues the shift of assigning increased power and responsibility for health and human services "safety net" programs from the federal level to the state level. Known as "devolution," this complex shifting of responsibility and accountability continues to evolve with increasing transference of authority, control, and administration of social programs to local governments, such changes require an informed citizenry and, hence, demand grassroots capacity building activities around public policy issues. This article describes a project designed to build the capacity of community-based organizations in several cities in Mississippi to become involved in health care policy activities. The primary purpose of this project was to inform and organize community members around improving health policies for low-income children and families. [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]

For some time, sociologists have debated whether physicians still retain dominance in the health care world, public faith in their moral and scientific authority, and the autonomy to set work conditions and make clinical decisions. Using ideas derived from this debate, we analyze the impact of changes in the health care environment on physician satisfaction. Our data come from a mailed survey of 510 Arizona physicians. Our results show that background physician attributes did not predict satisfaction, nor did most organizational attributes. However, participation in IPAs (Individual Practice Associations) predicted higher satisfaction, while payment according to a third party payer's fee-for-service schedule predicted lower satisfaction. In addition, physicians were more likely to be satisfied if they wrote the orders that non-physicians had to follow, were paid what they wanted, did not need to subordinate their clinical judgment to that of non-physicians, and believed that their patients had confidence in physicians. Our conclusions discuss both theoretical and policy implications of our findings. [ABSTRACT FROM AUTHOR]

There is near consensus that the US health care system requires reform. Only a quarter of the American public has faith in the current system'. Health care was one of the major issues considered in the 1992 US presidential election and the search for innovative solutions has transcended administrations. [ABSTRACT FROM AUTHOR]

This article discusses the status of federal health care policy under the administration of U.S. President Ronald Reagan. According to Health and Human Services Secretary Richard S. Schweiker, the future of health care under the Reagan administration can be described by competition and prevention. The administration intends to loose the forces in the market to make the health care system more competitive. It is believed that competition will prove to be the single greatest force for controlling prices. Health care policy in the first term of the Reagan administration is embodied in three major pieces of legislation, the Omnibus Budget Reconciliation Act of 1981, the Tax Equity and Fiscal Responsibility Act of 1982 and the Social Security Act Amendments of 1983. Although early on the administration tried to apply its philosophy of a limited size and role for the federal government to the health care sector, as costs continued to rise. The only ideology that seemed to dictate policy was that of balancing the budget. While policy analysts debated the philosophical implications of the new health legislation, the specter of government intervention in what was at one time the sacred domain of the medical profession grew even larger.

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 analysis of short-term medical and surgical hospitals in a nationwide sample of communities, we found a clear relation between physician characteristics and both variety and duplication of hospital-based health care services. Diversity of physician specialties was directly related to variety of hospital services in a community and altered the relation between hospital services and population characteristics such as education and age diversity. The ratio of physicians to the population was a strong predictor of the duplication of hospital-based services. While both financial and patient care personnel resources were also directly related to differentiation of services, per capita community income was not. Results emphasize the important role played by boundary-spanning agents, such as physicians, who channel resources and demands to organizations. Findings also indicate that health care policy designed to encourage an equitable distribution of facilities and providers should focus on the relation between hospital and physician. [ABSTRACT FROM AUTHOR]

The article focuses on the value of integration in the mental health service programs. Mental health professionals manage several outreach services like community care, community mental health education and community action to bring psychiatry close to the people. The author emphasizes the need for health professionals to be committed to the theory of integrating mental health policy into the mainstream health and welfare services.

The article presents views and insights of the authors concerning the argument for international action to regulate healthcare that crosses borders. The authors identify opportunities for increased cross-border trade in healthcare, ranging from tourists obtaining healthcare if they become ill while abroad to the establishment of foreign-owned healthcare facilities. They have also discussed the economic impact of the healthcare system.

This article reflects on the state of medical care in Great Britain, with specific reference to the annual review of the British health policy by the King Fund in its report "The King's Fund Review of Health Policy." The review is concerned with the final stages of the transformation of the National Health Service (NHS) in the wake of the NHS and Community Care Act 1990. The report reveals the increasing dissatisfaction with British health services.

A pressing concern in contemporary health policy is whether the medical profession’s mandate to take care of clients has been undermined by the influx of money into health care. We examine the medical profession’s transformation over the past decades. First, we review how sociologists have viewed the medical profession over the past half-century as one stakeholder among other stakeholders vying for market share and power in the health care field.We then examine three recent challenges to the profession that exemplify the tension between self-interest and collective altruism to act in the best interest of patients: (1) the rise of patient consumerism, (2) the advent of evidence-based medicine, and (3) the increasing power of the pharmaceutical industry. We show the resilience of the medical profession as it adapts and transforms in response to these challenges. We conclude with implications to help inform policy makers’ assessments of how the medical profession will react to policy initiatives. [ABSTRACT FROM PUBLISHER]