Rural health care can thrive if innovative tactics are used. Four principles can influence health care services: (1) an integrative approach is needed; (2) recognition that competition is a dominant mode; (3) cultural and professional ethnocentricity are counterproductive; and (4) the possibilities are limitless. (Author/MSE)

Factors affecting the optimal size of an integrated health care delivery system in an academic medical center are discussed, including: the institution's structure for survival; technology, innovation, and health care costs; and specific characteristics of the institution's education, research, and patient care missions. Several alternative…

Issues in balancing health services and costs in a changing society, where groups have differential access to health care, are discussed, including need for a universal health care system, growing cost of health care for the elderly, prolongation of life among older adults, and the claims of children on services. (MSE)

Seven common myths about rural America are debunked, and three characteristics of the rural environment (diversity, sparse population, and interdependency with broader social and economic forces) are examined in relation to health care delivery and medical education. Health care contributions to rural economic needs are discussed. (Author/MSE)

Ways in which the proliferation of competitive health care financing and service delivery systems based on managed care affects the financial support available to academic medical centers (AMCs), especially graduate medical education programs, are discussed. Analysis is based on case studies of AMCs. Trends, potential conflicts, and areas for…

The annotated and indexed bibliography contains over 120 citations of research and program reports from multiple health disciplines concerning rural health care delivery. Citations cover the period of January 1980 through July 1990, and are organized by state in which the program or research occurs. (MSE)

The Emory University (Georgia) Center for Clinical Evaluation Sciences is designed as an analytical resource for the university's health care delivery system and to promote health services research across the university. It also has potential as a resource for training medical students, house staff, and faculty in the evaluative clinical sciences.…

The traditional model for medical faculty development is inadequate in the face of shrinking government support, changes in biomedical research, changes in reimbursement systems, loss of respect for medical professions, and radical changes in the structure of the health care delivery system. Implications of changes in the health care system for…

Health care reforms will dramatically change the culture of medical schools in areas of patient care, research, and education programs. Academic medical centers must construct mutually beneficial partnerships that will position them to take advantage of the opportunities rather than leave them without the diversity of resources needed to make…

A solution to the rural health crisis will require not only changes in student selection, curriculum, and training location but also strengthening of the rural economy, improved reimbursement to rural hospitals and primary care physicians, and increased sensitivity among leaders of the medical profession to rural community and practitioner needs.…

With the support of outreach library services and visits by university-based faculty, area health education centers improve a rural community's ability to recruit, retain, and keep up-to-date primary care physicians and other health manpower. North Carolina is an example of this enhanced professional environment. (Author/MSE)

Steady urbanization and decreasing availability of health services for an aging rural population are occurring in Saskatchewan. Saskatchewan medical graduates find rural practice unattractive, and medical careers are not attracting rural youth. A comprehensive strategy of recruitment and reorganization of health care is needed. (MSE)

A survey of academic deans (n=100) in universities associated with medical and osteopathy schools found that administrators' attitudes about curriculum content are being influenced by changes in health care delivery and an increasingly generalist orientation. There appears to be support for medical school curricula fostering a broader, more…

This paper outlines forces that are intensifying change in health care delivery and describes institutional obstacles preventing medical schools' adjustment of their educational offerings. Health professions education institutions are urged to develop centers for determining regional and local workforce needs and subsequently establish regionally…

This article reviews societal demands for increased accountability and social responsibility by academic medicine. The Association of American Medical Colleges is urged to prepare more generalist physicians and assure better access to health care services. A "National System of Regional Medical Care" is proposed. (Author/DB)