INFORMATION TRADING

how information influences the health policy process

Marion Ein Lewin and Elise Lipoff, Editors

A Project of
The Robert Wood Johnson Health Policy Fellowships Program at the Institute of Medicine

Sponsored by The Robert Wood Johnson Foundation

NATIONAL ACADEMY PRESS
Washington, D.C.
1997



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INFORMATION TRADING how information influences the health policy process Marion Ein Lewin and Elise Lipoff, Editors A Project of The Robert Wood Johnson Health Policy Fellowships Program at the Institute of Medicine Sponsored by The Robert Wood Johnson Foundation NATIONAL ACADEMY PRESS Washington, D.C. 1997

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NATIONAL ACADEMY PRESS 2101 Constitution Avenue, N.W. Washington, DC 40218 NOTICE: This publication is based on a series of papers commissioned for the Annual Alumni Gathering of the Robert Wood Johnson Health Policy Fellows held on October 12-13, 1996. The views expressed are those of the authors and do not necessarily reflect those of the Institute of Medicine. The Office of Health Policy Programs and Fellowships at the Institute of Medicine, National Academy of Sciences, is the national program office for the Robert Wood Johnson (RWJ) Health Policy Fellowships Program, and in this capacity, provides overall direction and runs the day-to-day operations for the program. The RWJ Health Policy Fellowships Program is funded by The Robert Wood Johnson Foundation. For more information about the Fellowships Program, visit its home page at http://www2.nas.edu/rwj. The Institute of Medicine was chartered in 1970 by the National Academy of Sciences to enlist distinguished members of the appropriate professions in the examination of policy matters pertaining to the health of the public. In this, the Institute acts under both the Academy's 1863 congressional charter responsibility to be an adviser to the federal government and its own initiative in identifying issues of medical care, research, and education. Dr. Kenneth I. Shine is president of the Institute of Medicine. For more information about the Institute of Medicine, visit the IOM home page at http://www.nas.edu/iom. Support for this project was provided by the The Robert Wood Johnson Foundation. The opinions expressed in this publication are those of the authors and do not necessarily reflect the views of the sponsor. International Standard Book Number 0-309-05793-0 Additional copies of this publication are available for sale from the National Academy Press, 2101 Constitution Avenue, N.W., Box 285, Washington, DC 20055; call (800) 6246242 or (202) 334-3313 (in the Washington metropolitan area), or visit the NAP's on-line bookstore at http://www.nap.edu. Copyright 1997 by the National Academy of Sciences. All rights reserved. Printed in the United States of America

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Acknowledgments This book was truly a team effort, and it reflects the ideas and contributions of many different people. The use of information to shape and influence public policy has always been a subject of compelling interest, particularly in Washington, D.C., where information and information trading is the business, if not passion, of many groups and individuals. Shortly after the Robert Wood Johnson (RWJ) Health Policy Fellows come to town each year to begin their orientation they become aware of the importance and challenges of developing the information and the message that may hold the key for the eventual success or failure of a policy or position. Thus, it is fair to say, that this book was partially inspired by all of the Washington-based policy experts who graciously meet with the Fellows year after year and educate them on the content and process of health policy formulation. Special thanks go to Wendy Young and the other members of the 1995-1996 cohort who took major responsibility for developing the project. Deep appreciation is extended to all the contributors to this book. They took their assignments very seriously and also welcomed comments and suggestions on first, second, and sometimes third drafts, even if it meant another round of thinking and writing.

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Drafts of these papers were the focus of discussion and additional commentary at 1996 Alumni Day and at a breakout session at the 1996 Annual Meeting of the Institute of Medicine. Former Fellows Robert Crittenden, Jean Paul Gagnon, Nancy Gary, Myron Genel, Barbara Langner, and Marie Michnich also deserve special thanks for their helpful review and discussion of the papers at Alumni Day. With great appreciation, we thank the RWJ Health Policy Fellowships Program Advisory Board and its chair, Sheila Ryan, for encouraging us to do this project and for providing us with sound advice. We also thank Mike Hash, Janet Kline, and Janet Shikles, who generously contributed their respected expertise and balanced views by allowing us to "reality-test" some of the ideas in this book with them. Great gratitude goes to a number of people at the IOM who contributed to the successful completion of this project in substantive ways. They include Clyde Behney, Nancy Diener, Mike Edington, Karen Hein, Linda Humphrey, Valerie Tate Jopeck, Justine Lang, and Kenneth Shine. Deep appreciation goes to Michael Hayes for his fine and thoughtful editing of the volume. Last, but not least, our special thanks go to all those who work with us at The Robert Wood Johnson Foundation, for allowing the Fellowships Program the opportunity to develop this special project and for having the confidence in us to let us bring it to fruition. Marion Ein Lewin and Elise Lipoff

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Contents     Foreword and Introduction Marion Ein Lewin   1 1   The Market for Information in Health Policy: Using the "Just-in-Time" Strategy Wendy B. Young   11 2   Funding Graduate Medical Education in the Year of Health Care Reform: A Case Study of a Health Issue on Capitol Hill Oliver Fein   27 3   The Use of Information and Misinformation in a State Health Reform Initiative Robert G. Frank and Coleen Kivlahan   49 4   The Role of Graduate Medical Education Consortia in the Postregulatory Era in New York State Benjamin K. Chu   71

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5   Information Trading, Politics, and Funding for the National Institutes of Health in the 104th Congress David P. Stevens   88 6   Gene Mapping and Genetic Testing, Promises and Problems: A Case Study on an Emerging Technology P. Pearl O'Rourke   99 7   The Information Trading Process: The Case of Medicare Payment Equity Susan Bartlett Foote   120     About the Authors   136

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INFORMATION TRADING

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