clinical research and training may disproportionately fall on public-sector institutions, such as the U.S. Department of Veterans Affairs (VA), the largest provider of health care training in the United States and one of the largest research organizations in the world (Appendix A).

The transformation of the U.S. health care system to one of managed care may be the single most important development in health care delivery since the rise of modern medicine and the advent of health insurance. Because managed care organizations now claim enrollment of more than 150 million Americans, this transformation has not only altered the relationships between patients and independent providers but has also changed Medicaid from a fee-for-service government health insurer into a large-scale purchaser of private insurance. To improve health outcomes, public and private purchasers of health care—particularly large employers, the Health Care Financing Administration, and state Medicaid agencies—should form partnerships with public health agencies (CDC, 1995). These new arrangements, combined with collaborative efforts with managed care organizations, could greatly improve community health while containing health care costs.

Clearly, assessment of the impact of managed care on the control of emerging infectious diseases is complicated by the rapidly changing environment of the U.S. health care system. Managed care is changing the type and quality of health care that many Americans receive. By promoting the integration of health care services, including public health, managed care could enhance not only the continuity of care but its quality as well.


Jonathan R. Davis, Ph.D., Editor

In the rapidly changing environment of health care delivery and financing, the impact of managed care on infectious disease surveillance, research, and prevention impelled this workshop on the part of the Institute of Medicine (IOM) Forum on Emerging Infections to assess the opportunities and challenges posed by changes in this environment. In developing the workshop agenda, Forum members identified five key areas for discussion: (1) basic and clinical infectious disease research, (2) clinical practice guidelines, (3) emerging infections surveillance and monitoring, (4) education and outreach, and (5) drug formularies and product development. This workshop summary is organized according to these five key areas (Chapters 2 to 6, respectively), followed by concluding remarks (Chapter 7), references, and a series of appendixes (Appendix A, the Veterans Health Administration and Infectious Disease; Appendix B, Glossary and Acronyms; Appendix C, Workshop Agenda; and Appendix D, Forum Member and Staff Biographies).

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