health status and the impact of health care reform: evaluating and improving measures of child health, developing the capability to assess both short-and long-term effects of illness and health care on children's health status, instituting longitudinal data collection (e.g., through panel surveys), expanding national surveys so that they can produce state-level estimates, and developing the capability specifically to monitor vulnerable child populations.

As changes are made in the health care system to control costs and improve access to services, changes should also ensure that the quality of care is protected and improved. To ensure that children receive appropriate care, the available, but still limited, tools for assessing their health status and health care need to be used as effectively as possible. Development of a more comprehensive set of quality indicators will require rigorous studies that examine the effectiveness of various elements of children's care. Programs to monitor quality of care will need to establish accountability for correcting problems that may be found and mechanisms to ensure that improvements are made.

Institute of Medicine 1988 The Future of Public Health. Division of Health Care Services. Washington, D.C.: National Academy Press.

1990 Medicare: A Strategy for Quality Assurance. K.N. Lohr. ed. Vol. 1. Division of Health Care Services. Washington, D.C.: National Academy Press.

1994 America's Health in Transition: Protecting and Improving Quality . Division of Health Care Services. Washington. D.C.: National Academy Press.