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vides an increasingly accessible communications channel for a growing segment of the population. Moreover, in comparison to television—also a widely available medium for reaching consumers—the Internet offers greater interactivity and better tailoring of information to individual needs. These capabilities may lead to significant changes in consumer behavior (e.g., cessation of smoking, changes in diet) that could greatly improve health.

Ongoing trends in health care are likely to reinforce the shift toward consumer-oriented health information. Since the mid-1960s, patients have been encouraged to take a more active role in their own health care, and care providers have recognized the value of engaging patients to participate more meaningfully in their own care. Furthermore, attempts by care providers and managed care plans to streamline services and cut costs have shortened hospital stays, increasing the need for patients and their families to understand how to provide care themselves. Greater emphasis is being placed on preventive care, which requires consumers to understand health risks and the effects of different behaviors (such as smoking and dietary habits) on their health. These trends heighten the need for consumers to have access to reliable health information and open channels of communication to care providers and other health professionals.

Consumer health initiatives that rely on the Internet reflect, and could even drive, significant changes in the structure of the health care industry. Concurrent with changes in the economics of the health care delivery system, the duration of a medical consultation is steadily declining, and the availability of practitioners for substantive discussions between visits is decreasing. Continuity of care is increasingly disrupted as patients change care providers in response to changes in their health insurance plans. These trends favor consumers who are well informed and autonomous. Consumer health initiatives attempt to involve patients more actively in care-related decision making and enable them to exercise greater control over their health. Indeed, the Internet could change the culture of health care from one in which patients are viewed as recipients of care to one in which they are partners in care. Eventually, they may be able to use the Internet to access and update their personal medical records or receive care in their homes.

Consumer-Oriented Health Web Sites

Over the past few years, leading providers of health information have identified the Internet as an effective medium for reaching large numbers of health consumers. The most visible aspect of this recognition is the explosion of Web sites geared to consumer health issues (Table 2.1). These sites are dedicated to the diagnosis and management of diseases, thecontinue



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