the state of the art. However, the committee agreed that overall responsibility should be assigned to the U.S. Department of Health and Human Services. The challenge for the Secretary of Health and Human Services will be to delegate authority to the appropriate agency within the department to ensure an institutionalization of the monitoring function.

In the past, the following criteria (DeNeufville, 1975) have been important for successful institutionalization of social indicators throughout the federal government:

  • the agencies that collect and manipulate the data should be respected and not subject to immediate political control,

  • long-term financing and regular production of measures can be depended upon,

  • the data are presented in a nonpolitical context,

  • processes are established and followed for orderly changes in concepts and methods, and

  • institutional arrangements exist to use and analyze the measure in connection with policies.

In applying these criteria the Secretary will need to decide whether to use an existing unit or create a new organization. An existing unit has the advantages of a track record and experience in garnering support. The disadvantage is that the monitoring function would compete with established functions for resources and attention.

The committee believes that the appropriate locus of responsibility for the access monitoring activity is the federal government. Nevertheless, it recognizes the important role that private foundations can play in stimulating government action and funding research and demonstration activities.

Racial and Ethnic Differences

Anyone reading this report will be struck by the persistent and in some cases widening disparities between access to health care for blacks and access for whites. Studies of health care access that compare the experience of whites with that of racial and ethnic minorities other than blacks frequently reveal similar disparities. When certain factors, such as insurance status and income, are taken into account, some of the disparities diminish. However, there is a continuing need to oversample minorities in national surveys as well as to conduct specialized surveys focused on them.

Recommendation. Because it is not always feasible to improve the accuracy of national data bases in recording the race or ethnicity of patients, it will be necessary to mount studies that better reveal the nature of unexplained access problems for minorities.

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