Shaping a New Health Care System The Explosion of Chronic Illness as a Catalyst for Change

In Part One we introduce the reader to chronic illness, the U.S. health care system's approach to chronic illness, and the need for the system's major reform. We also provide a conceptual model of the experiences of the chronically ill. In Chapter One we briefly introduce our perspective on the implications of chronic illness for the U.S. health care system. In Chapter Two we address the prevalence and complex nature of chronic illness, and in Chapter Three we summarize some of the major responses of the health care system to the increase in chronic illness. We discuss the weaknesses of the conventional acutecare approach to chronic illness in Chapter Four, noting the various criticisms that have been made of it and the critics' suggestions for how long-term illness and disabilities could be managed. We also point out how we agree and disagree with the critics. In Part Two we illustrate how the ill and their marital partners experience chronic illness and its management. These experiences have implications for health care policy, some of which are pointed out in the accompanying commentaries. Chapter Five is central to this book, for in it we offer our new theoretical framework for dealing with chronic illness and its increasing influence on the U.S. health care system and policies. In Chapters Six through Nine we describe four distinctly different stages of chronic illness: comeback phases, stable phases, unstable phases, and deterioration. In each chapter we present case illustrations and commentaries on relevant policy. In Part Three we summarize the implications for health care practice and policy that can be derived from the case illustrations provided in Part Two. In Chapter Ten we detail some of the possible effects on health care practitioners of adopting our framework. And in Chapter Eleven we summarize our conceptual model and present some of the major policy implications of our perspective.