Assessing Health Care Reform

Committee on Assessing Health Care Reform Proposals

Marilyn J. Field, Kathleen N. Lohr, and Karl D. Yordy, Editors

Division of Health Care Services

INSTITUTE OF MEDICINE

NATIONAL ACADEMY PRESS
Washington, D.C.
1993



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Assessing Health Care Reform Assessing Health Care Reform Committee on Assessing Health Care Reform Proposals Marilyn J. Field, Kathleen N. Lohr, and Karl D. Yordy, Editors Division of Health Care Services INSTITUTE OF MEDICINE NATIONAL ACADEMY PRESS Washington, D.C. 1993

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Assessing Health Care Reform NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, D.C. 20418 NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for this report were chosen for their special competences and with regard for appropriate balance. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy’s 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. This study was supported by the W. K. Kellogg Foundation endowment fund. Library of Congress Catalog Card No. 93-84089 International Standard Book Number 0-309-04926-1 Copyright 1993 by the National Academy of Sciences. All rights reserved. Additional copies of this report are available from: National Academy Press 2101 Constitution Avenue, NW Washington, DC 20418 B150 Printed in the United States of America First Printing, April 1993 Second Printing, October 1993 Third Printing, March 1994 The serpent has been a symbol of long life, healing, and knowledge among almost all cultures and religions since the beginning of recorded history. The image adopted as a logotype by the Institute of Medicine is based on a relief carving from ancient Greece, now held by the Staatlichemuseen in Berlin.

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Assessing Health Care Reform COMMITTEE ON ASSESSING HEALTH CARE REFORM PROPOSALS WALTER J. McNERNEY (Chair),* Professor of Health Policy and Consultant, J. L. Kellogg Graduate School of Management, Northwestern University, Chicago LONNIE R. BRISTOW,* Private practice of internal medicine, San Pablo, California DON E. DETMER,* Professor of Surgery and Vice President for Health Science, University of Virginia, Charlottesville CLAIRE M. FAGIN,* Professor, School of Nursing, University of Pennsylvania, Philadelphia JEROME H. GROSSMAN,* Chairman and Chief Executive Officer, The New England Medical Center, Boston MARGARET C. HEAGARTY,* Director of Pediatrics, Harlem Hospital Center, and Professor of Pediatrics, College of Physicians & Surgeons, Columbia University, New York, New York JOSEPH P. NEWHOUSE,* John D. MacArthur Professor of Health Policy and Management, Division of Health Policy Research and Education, Harvard University, Boston EDWARD B. PERRIN,* Professor and Chairman, Department of Health Services, University of Washington, School of Public Health and Community Medicine, Seattle GARY TISCHLER, Professor and Chairman, Department of Psychiatry and Biobehavioral Sciences, University of California at Los Angeles, School of Medicine REED V. TUCKSON, President, Charles R. Drew University of Medicine and Science, Los Angeles *   Member, Institute of Medicine

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Assessing Health Care Reform STUDY STAFF Marilyn J. Field, Principal Staff Officer Kathleen N. Lohr, Deputy Director, Division of Health Care Services Karl D. Yordy, Director, Division of Health Care Services Holly Dawkins, Research Assistant, Division of Health Care Services Don Tiller, Administrative Assistant, Division of Health Care Services

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Assessing Health Care Reform Contents     PREAMBLE   1     EXTENDING ACCESS TO HEALTH CARE   5     Barriers to Access   6     Financial Access   7     More than Financial Access   15     CONTAINING HEALTH CARE COSTS   21     Costs in Context   21     Elements of a Strategy   22     Moving from General to Specific Policies   27     ASSURING THE QUALITY OF CARE   33     Defining Quality   34     Quality Measurement and Improvement   35     Clinical Practice Guidelines   39     Specific Implications   41     FINANCING REFORM   45

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Assessing Health Care Reform     IMPROVING THE INFRASTRUCTURE FOR EFFECTIVE CHANGE   51     Governance and Administration   52     Human and Physical Capital   55     Knowledge Development   58     Public Health Policies and Programs   64     Other Infrastructure Issues   65     CONCLUSION   71     REFERENCES   73

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Assessing Health Care Reform Assessing Health Care Reform

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