Since Abraham Lincoln approved the Congressional charter of the National Academy of Sciences in 1863, the Academy complex—now made up of the National Academy of Sciences, the National Academy of Engineering, the Institute of Medicine, and the National Research Council—has been advising government about the impact of science and technology on society. The Academy complex provides independent advice to government by appointing committees of experts who serve without compensation, asking these committees to prepare draft reports by consensus, and subjecting these drafts to rigorous independent scientific review before release to ensure their quality and integrity. To avoid potential conflict of interest and bias, careful attention is given to the composition and balance of study committees.

As the 21st century approaches with science and technology assuming increasing importance in society, the Governing Board of the National Research Council has synthesized, summarized, and highlighted principal conclusions and recommendations from recent reports to inform decisions in a number of key policy matters. The resulting series of papers do not address all the intersections of science and technology with public policy, but they do address some of the most important. They are directed to federal administrators, members of Congress, corporate and business executives, managers and professionals, leaders of nongovernmental organizations, and all others involved in the development and implementation of public policies involving science and technology.

This paper discusses policies that can improve the quality of the nations ever-changing health care system. Previous reports from the Academy complex, particularly the Institute of Medicine, have examined the strengths and limitations of health care in the United States and have recommended strategies to evaluate and improve the quality of health care. Those reports have encouraged and influenced both public and private initiatives to define and monitor the quality of care, measure health outcomes, develop better evidence and guidance on the appropriate use of medical services, and organize systems to improve health services and outcomes. The issues summarized in this paper from past reports continue to be relevant to the work of the Academy complex and to the nation.

This document with direct links to the text of all reports cited herein, is available on the Internet at http://www2.nas.edu/21st. A box at the end describes other ways to obtain information on the Academy complex and the topics discussed in this paper.