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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