mandates, circumvent court-ordered coverage in individual cases, rewrite malpractice laws, reduce administrative costs through single-payer arrangements, and limit the coverage eligible for tax deductibility.

Some reforms—for example, those that envision practice guidelines as the basis for defining a basic benefits package for all health insurance plans— would put a premium on the kinds of credible, accountable processes for developing and applying guidelines that are described in this report. The danger in such proposals is that the potential contributions guidelines have to make in improving the quality of health care and health outcomes may be lost in a perception that guidelines serve only cost-containment purposes. The committee sees, therefore, both unprecedented opportunities for the clinical practice guidelines movement as well as exceptional challenges in the years ahead.