dent living movement is gaining momentum and increased acceptance and visibility, the U.S. society is witnessing a revolution in health care, that in general, places more emphasis on consumer preferences and expectations (Relman, 1988). Never before has the consumer's point of view of how well he or she is doing been so important. Their views and preferences are being used by clinicians in making treatment choices, by third-party payers in deciding what to pay for and what not to pay for, and by administrators and policy makers who are making difficult decisions regarding the allocation of expensive resources at the level of the individual practice as well as across society as a whole (Ellwood, 1988; Epstein, 1990). These similar perspectives on the important role of the consumer provide a unique opportunity for the fields of rehabilitation science and engineering and HSR to work together closely in the development and evaluation of health care delivery models that incorporate a consumer orientation toward the identification of needs and appropriate strategies for meeting those needs.

A third and important trend that will influence the agenda of HSR in rehabilitation science and engineering is the continued interest in health care reform with an emphasis on cost-containment and value. New and innovative approaches to the organization, financing, and delivery of health services are being proposed. It is imperative that the rehabilitation field take aggressive and proactive steps toward evaluating the potential impacts of these changes on access, quality, and outcomes of services for people with disabling conditions.

The following pages summarize the major HSR issues that need to be addressed over the next decade. These issues have been identified through a review of several major publications that have documented the need for and current deficiencies in the current HSR agenda as it pertains to people with disabling conditions. This review is followed by a discussion of alternative strategies for improving the interface between the fields of HSR and rehabilitation science and engineering.

Before proceeding, however, it is important to point out two caveats to the discussion. First, the committee chose to focus on the current status and needs for HSR as it pertains to the delivery of health services and health-related support services only. These services have been defined as encompassing (1) medical rehabilitation services required for improving and maintaining function, (2) primary health care services for health maintenance and the prevention of secondary conditions, (3) long-term institutional care for those unable to live in the community, and (4) support services including personal assistance services and assistive technologies