For almost 25 years, the IOM has contributed to many pivotal health policy issues. As its 1993 monograph, Assessing Health Care Reform, asserts, leaders in both the public and private sectors must ensure that a reformed health care system delivers high-quality care at an affordable price to all and be ever vigilant to the risks to quality of care that change may bring. Those who are responsible for enacting and enforcing public policy and for determining the future shape of health care in the United States must identify the public agencies and private groups that shall be responsible for overseeing quality measurement and specify to whom those organizations shall be accountable. Such policymakers must also:

  • identify the populations for whom quality of care shall be monitored, from individuals and members of health plans to groups with special health needs, communities, and the nation as a whole;

  • confront the full range of quality-of-care problems, including overuse and underuse of services as well as deficiencies in the technical and interpersonal aspects of health care;

  • stipulate that quality measurement include evaluation of structural elements, processes, and outcomes of care;

  • create reliable uniform data systems and collect consistent data from a variety of sources;

  • apply and refine tools and techniques of quality measurement and improvement that will help health care reform succeed;

  • devise means of providing valid, useful information on health care quality to consumers, providers, payers, and policymakers; and

  • promote communication and education among all elements of society about quality of care and the use of quality measures.

Concerns about quality of care are no excuse to delay or thwart health reform. They are a compelling reason to confront quality matters with the same vigor and sophistication as will be directed at issues of access and cost.

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