At this early point in its deliberations, the committee is inclined to believe that although the passage of national health care legislation would further enhance the need for health services research, it would not significantly shift the basic course of this field. New or different sponsors of research may emerge, depending upon which entities are held accountable for which decisions and outcomes. National health reform is expected to provide unique opportunities to set goals and then to monitor progress toward health and health care objectives —and to point out when changes are necessary. The questions of access, cost, and quality must be addressed, however, with or without national reform.

Along with documenting the wide reach of health services research today, the committee concluded it should give some attention to broad directions in which the field might be expected to move and to specific issues that will call on the expertise of health services researchers. This section of the committee's interim statement describes a range of projects and developmental objectives that are challenges for the future. Although the committee's listing is quite selective, it includes areas that illustrate the philosophical, academic, and applied elements of health services research.

Organization and Financing of Care

As the nation has debated health care reform during the past 2 years, the public has become increasingly aware of the issues of health care organization and finance that health services researchers have long addressed. For example, researchers: develop Medicaid managed care programs; design integrated hospital systems to maximize population health; study the impact of various state health policy experiments on the health of their citizens; explore the role of public- and private-sector partnerships in achieving the most appropriate balance between public and private hospital beds in a variety of policy scenarios; compare outcomes of dental hygiene treatment in managed-care and fee-for-service settings; investigate



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