The quality assurance and improvement program outlined in health reform proposals ought to include specific responsibilities for identifying and overcoming system and policy barriers to improved performance.

Reform proposals should mandate that a quality assurance and improvement program track the effects of certain cost containment processes.

Practice guidelines are in a relatively embryonic state of development, especially insofar as cost containment, design of basic benefit packages, and other endeavors key to health care reform are concerned. Thus, as the committee as already suggested in its discussions of access and cost containment, health care reform proposals should not place more burdens on guidelines for solving problems of cost control, benefit package design, rationing, competition, administration, or quality than they, at their present stage of development, can sustain.

A formal, nonjudicial mechanism by which individuals can voice grievances and obtain assistance should be available to all as the nation moves through the next few years of experimentation and change. This committee recommends that health care reform proposals mandate an additional responsibility of a quality assurance and improvement program—namely, to serve as a focus for consumer complaints or as an ombudsman.

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