THE RICHARD AND HINDA ROSENTHAL LECTURES

1993-1994

Preparing for a Changing Healthcare Marketplace

Lessons from the Field

INSTITUTE OF MEDICINE



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Preparing for a Changing Healthcare Marketplace: Lessons from the Field THE RICHARD AND HINDA ROSENTHAL LECTURES 1993-1994 Preparing for a Changing Healthcare Marketplace Lessons from the Field INSTITUTE OF MEDICINE

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Preparing for a Changing Healthcare Marketplace: Lessons from the Field Copyright 1995by the National Academy of Sciences . All rights reserved. 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 advisor 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.

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Preparing for a Changing Healthcare Marketplace: Lessons from the Field Foreword Six years ago an exciting and important new program was launched at the Institute of Medicine. Through the generosity of the Richard and Hinda Rosenthal Foundation, a lecture series was established to bring to greater attention some of the critical health policy issues facing our nation today. Each year a subject of particular relevance is addressed through three lectures presented by experts in the field. The lectures are published at a later date for dissemination to a broad national audience. The Rosenthal programs have attracted an enthusiastic following among health policy researchers and decisionmakers, both in Washington, D.C., and across the country. Our speakers have been leading experts on the subjects under discussion. Our audience has included many of the major policymakers charged with making our health care system more effective and humane. The lectures and their associated remarks have engendered lively and productive dialogue. The Rosenthal lecture proceedings included in this volume focus on a number of leading topics that were highlighted as part of the historic national debate on health care reform, such as: the changing role of employment-based health insurance; managed care and vulnerable populations; and the role and responsibilities of states in health care reform. Although national health care reform legislation did not come to pass, these topics remain central issues in the current dialogue on making the health care marketplace more efficient, affordable, and

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Preparing for a Changing Healthcare Marketplace: Lessons from the Field community-oriented. There is much to learn from the informed and realworld perspectives provided by the contributors to this book. I would like to give special thanks to Jerome Grossman and Harold Luft for sharing moderator duties for the 1993–1994 lectures. In addition, I would like to express my appreciation to Marion Ein Lewin for directing the Rosenthal programs and to her assistant, Valerie Tate Jopeck, for ably handling the many logistical details associated with the lecture programs and the publication. No introduction to this would be complete, however, without a special expression of gratitude to Richard and Hinda Rosenthal for making this valuable and important educational effort possible. Their attendance at our Rosenthal events and their keen interest in the themes under discussion further enrich this valuable IOM activity. Kenneth I. Shine, M.D. President Institute of Medicine