Part 1 Changing consumer perspectives in today's health care environment: managed care - the changing environment for consumers and health care providers; on being a proactive health care consumer - making an "unresponsive" system work for you; consumer desire and medical practice; using social network principles to structure linkages between providers and patients. Part 2 Specific technologies and programs: hospital technology-environment interplay as determinants of mortality; the history of nursing home bed supply in Chicago - the effect of federal policy and urban settlement on utilization; computer tools and shared decision making - patient perspectives of "knowledge coupling" in primary care. Part 3 Technology and providers: predictors of continued use of telemedicine by primary care professionals, medical specialists and patients; managing mental illness - trends in continuing mental health education for family doctors, 1977-1996. Part 4 Issues of changes for specialized patients - people with serious illnesses: using action research to improve collaboration between breast cancer patients and physicians - creating the programme for collaborative care; health determinants among persons with traumatic injuries - a comparative analysis using the sickness impact profile; the extended self - illness experiences of older married arthritis sufferers.