committee's recommendations should be subject to the same type of ongoing evaluation as the reforms themselves.

The complexity of the health care system—and of health itself—presents major challenges to reform, and these challenges are intensified by the many important and often contending interests that have a stake in both the broad directions and intricate details of policy change. Reform proposals that focus primarily on financial issues and goals without recognizing that improved performance requires significant changes in how health care is organized and provided are unlikely to achieve the goals outlined here. Reform proposals must indicate their general approach to questions such as how health care professionals are to be appropriately trained and deployed (including expected responses to market signals from revised incentives), how better information is to be marshalled to improve performance, and how quality of care can be maintained and improved within resource constraints.

Finally, the reform of our health care system should be undertaken in the same spirit of continuous improvement and renewal that has so often been the keystone of success in America. The profound changes required for effective reform, even when the nation builds on the existing strengths of its health care system, demand that we learn from experience. To do that we need good information and sound analyses of results, flexibility and creativity in responding to that information, and an abiding focus on the concerns of the people whose health and well-being we seek to improve.



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