THE RICHARD AND HINDA ROSENTHAL LECTURES

1992-1993

Changing the Health Care System

Models from Here and Abroad

INSTITUTE OF MEDICINE



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Changing the Health Care System: Models from Here and Abroad THE RICHARD AND HINDA ROSENTHAL LECTURES 1992-1993 Changing the Health Care System Models from Here and Abroad INSTITUTE OF MEDICINE

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Changing the Health Care System: Models from Here and Abroad Copyright 1994 by 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 for 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.

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Changing the Health Care System: Models from Here and Abroad Foreword Five 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. We have been privileged to have as speakers leading experts on the subjects under discussion. We have been pleased to have in our audience 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. As our nation embarks on an historic journey towards health care reform, there has been growing interest in learning more from the experiences of countries such as Canada, the United Kingdom, The Netherlands, and Germany, which provide universal coverage within the boundaries of some type of expenditure constraints. The lectures in this volume go far in illuminating our understanding of how other countries deal with some of the pivotal issues at the heart of the current dialogue on health care restructuring: financing, technology innovation and diffusion, the role of primary care, and global budgeting.

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Changing the Health Care System: Models from Here and Abroad I would like to give special thanks to John Iglehart for moderating the 1992–1993 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, 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 loyal 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