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2020 Vision: Health in the 21st Century Concluding Remarks Kenneth I. Shine, M.D. President, Institute of Medicine The presentations in this volume focus a good deal on interactions—interactions between health and fertility, between health and poverty, between mathematics and biology, and between education and science. They also highlight the relationships between the private and the public sectors, between profit and not-for-profit medicine, between the different health disciplines and the need to bring together—and, with hope, to educate together—a variety of providers who can function as an integrated team, and the need to reexamine the relationship between academic health centers and the communities in which they operate. As one step along that route, the Academy and the Institute have committed funds to bring representatives of 20 academic health centers and the local community schools with which they work to Washington for a five-day institute. At that time, we will introduce them to the new science standards, given them some experience with inquiry-based learning, and show them how to disseminate these science standards. If that works, we will do 20 more, and 20 more after that until all of the academic health centers have been involved in this process. As our Nobel Laureate, Baruch Blumberg, has clearly articulated, we need to protect our capacity to generate new knowledge, and we need to understand the relationship between genetics and the environment, between behavior and illness. As someone who has spent his life studying virology and molecular biology, Dr. Blumberg is as eloquent as anyone could be with regard to the necessity to connect science to people all over the world. At the Institute, we will continue our commitment to improve and increase the acquisition and dissemination of scientific knowledge. As IOM approaches its next 25 years, we will also continue our commitment to educate the new generations of health care providers. That in-
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2020 Vision: Health in the 21st Century cludes a commitment to achieving balance in the health care workforce—an idea exemplified by the IOM's 1978 recommendation that 50 percent of all physicians graduating from medical school should be primary care providers. Now that managed care is expanding, we have an opportunity to focus not on the numbers, but on the quality and nature of primary care. Finally, and most important, we must remain true to one of our most cogent values: our commitment to quality health care for all. In pursuit of that, we have established a roundtable on quality and have various other projects underway concerning the assessment of quality of care. This gives us a way to regularly evaluate the nature of the services that are provided to our citizens, their access to care, and the way in which the system responds to their needs. In addition, the Institute's special initiative on quality of care is designed to examine objectively and analytically the way in which the health care system operates so we can periodically tell the nation what is happening to quality of care and access around the country. Although a good deal of the discussion at the symposium was focused on developments in the managed care environment as they relate to market share and for-profit activities, I should emphasize that IOM's commitment to access to care for all means that we will be steadfast in examining the way in which the changing health care scene provides care to all elements of society and to all of our citizens—the poor, the elderly, the indigent; those whose opportunities for care are limited by distance or by cost; and those who are put at risk because the consolidation under way in the health system may leave them on the outside looking into a health system that does not include them. We here at the Institute are excited about the next 25 years. Let us hope that in 2020, our dream of quality health care for all Americans will have been realized.
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