care is worth paying for. It recommended instead that developers concentrate on providing the clinical information, judgments, and rationales on which policy makers, payers, managers, and others might base such decisions.

Some proposals for reform include provisions for cost containment that incorporate roles for clinical practice guidelines in defining or administering basic benefit packages, strengthening health plan competition and consumer choice, or restructuring malpractice decision making. The specifics vary, but the basic ideas are that the reforms would do one or more of the following: override state benefit mandates, circumvent court-ordered coverage in individual cases, rewrite malpractice laws, reduce administrative costs through national or regional administrative and regulatory structures, and limit the coverage eligible for tax deductibility. These and other proposals for health care reform raise many questions that are beyond the scope of this committee's charge. Some reform proponents envision sweeping changes in the nation's health care delivery and financing systems that would certainly place guidelines in a framework of incentives for cost containment that is much different from what currently exists.

Some reforms—for example, those that foresee 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 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 are to serve only cost-containment ends. The committee sees, therefore, both unprecedented opportunities for the clinical practice guidelines movement and exceptional challenges as well in the years ahead.



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