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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.
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National Academy Press
2101 Constitution Avenue, NW Washington, DC 20418
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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.
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
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