Volume 74 Number 2, 1996
In This Issue:
Paul D. Cleary, Editor
A fundamental imbalance of power in inherent in the physician-patient relationship. No matter how much they educate themselves, patients will never be able to match the accumulated knowledge and experience of their physicians. Therefore, patients have to trust that physicians are acting in their best interests, that they are competent, that they are imparting appropriate information, and that they will guard as confidential the information shared during treatement. David Mechanic, in "Changing Medical Organization and Erosion of Trust," describes the changes in the organization and financing of health care that are challenging the physician-patient bond. Mechanic describes current initiatives and suggests measures that individuals and institutions can take to restore trust.
Rosemary Stevens edits an ongoing series of articles that explore recent and anticipated changes in acute care hospitals (see James C. Robinson, "The Changing Boundries of the American Hospital," MQ 72:2; John D. Stoeckle, "The Citadel Cannot Hold," MQ 73:1; Stephen M. Shortell and colleagues, "Reinventing the American Hospital," MQ 73:2; Rudolph Klein, "Big Bang Health Care Reform," MQ 73:3; and Hugh L. Freeman, "The General Hospital and Mental Health Care: A British Perspective," MQ 73:4). In this issue, Chris Ham, writing on "Population-Centered and Patient-Focused Purchasing: The U.K. Experience," explores a critical feature of the reformed National Health Care Service in the United Kingdom: the separation of responsibility for purchasing and providing health care. Although Ham finds advantages in the splitting of purchasing responsibility between the Health Authorities and the general-practitioner Fundholders, he envisions problems if their decisions are not coordinated.
Economically and socially disadvantaged cancer patients have higher mortality rates than other cancer patients, but the reasons for this discrepancy have not been clear. Howard Greenwald and colleagues report on the results of previous research and of a newly completed tem-year survival study in their article, "Explaining Reduced Cancer Survival among the Disadvantaged." They conclude that improving access to health care will reduce, but probably not eliminate, the differential mortality in some malignancies. Oureach and monitoring of public health risks would continue to be important.
Mary Mahowald and colleagues, authors of "The New Genetics and Women," discuss the ways in which women are likely to be affected by the findings of the U.S. Genome Project (HGP). Few studies of the project have focused on gender-specific ethical and policy issues. By identifying gender differences as a subject with potential impact on research and clinical practice and on other areas of public life, they hope to stimulate and inform public discussion and policy.
Although a great deal of medical and health services research and policy discussion focuses on cancer and heart disease, which are the laeading causes of death in the United States, infectious diseases still contribute significantly to mortality. In this issue, Jason S. Lee points out, in "Adult Immunization Priorities in the United States," that pneumonia and influenza together compromise the nation's sixth leading cause of death. Even though vaccination against these diseases is fully reimbursed by Medicare, one-half to to three-quarters of older adults fail to recieve such protection. Lee compares the expenditures of funds for the immunization of children and adults and argues that adult services should be emphasized more than they are now.
