Committee on Labor and Public Welfare, praised the council for providing an "important forum for joint government and private cooperation to promote the development of methods of health care technology assessment." ³⁰

Although this important council proved short-lived, it showed a new willingness of the IOM to experiment with entities other than study committees in order to influence health care policy—another sign that the IOM had come out of its early 1980s malaise. Indeed, by the end of the decade, many of the problems cited in the 1984 Sproull report had been resolved. The key factor was that the absence of a financial burden gave the IOM a new freedom to set its own agenda. Samuel Thier feared that the National Research Council, with its ethos of service, had become a "job shop" that responded to all requests for assistance. He preferred that the IOM take charge of its own activities, even at the expense of turning down some requests. In this spirit, the IOM began to scrutinize requests far more carefully than it had previously.³¹

At the same time, the IOM contemplated formulating its own requests. The Board on Health Care Services wanted to focus the attention of the Institute of Medicine on the broad question of access to health care services. This topic, with its breadth and complexity, resembled the sort that the Board on Medicine had once hoped to address. In the intervening years, the IOM had discovered, however, that few foundations or government agencies wished to finance studies that appeared to be diffuse and unrelated to political realities. Even though the IOM had managed to secure NRC approval for such studies, it had seldom been able to gather enough money to get them under way. In October 1988, the Board on Health Care Services tried again, proposing that the IOM develop a statement of objectives on this topic, issue an annual status report on health care access in the United States, sponsor a structured debate on critical policy issues, and perform in-depth studies that would generate policy recommendations. Thier, for his part, recognized that the topic was of interest to a broad segment of the IOM membership.³²

Although the IOM never carried out the ambitious program suggested by the Board on Health Care Services, the theme of access became central to the IOM's operations in 1989. "The quality, access, organization, and financing of preventive and clinical services," emerged as the first of six cross-cutting themes that the IOM used to describe its program and identify its priorities. Identification of the themes by the Program Committee marked an explicit effort to "bind program efforts together and bring cohesion to disparate efforts." The annual report for 1989 included a chart that matched each of the