Perspectives in Western health care.

Eleven trends in health care and society are described and used in the construction of a future scenario for health care in Western society: 1) involution in the field of specialist medicine; 2) an epidemiologic shift from acute illness to chronic impairment; 3) more self care and mutual care; 4) more self-responsibility in health maintenance; 5) de-institutionalization; 6) changing personal values and goals; 7) revival of emotional life; 8) new appraisal of dying; 9) towards a participative society; 10) uncoupling the health care wages; 11) the emergence of a "dual strata" society. In such a society, the medical dominance in the health care system will regress. Health maintenance based on more competent self care and social networks, and similar approaches to care for patients with chronic illness, will balance a more restricted medical intervention system.

The demise of the hospital.

We observe a mounting strain between the consumer's demand for increasing amounts of health care, and a network of hospital services that becomes increasingly difficult to maintain. Can adjustments be initiated short of crisis to break the present cycle and prevent the derailment of the entire clinical system?