ally transmitted diseases. It is possible that some HMOs will garner a competitive advantage in being viewed as progressive, research-oriented organizations. Major purchasers of managed care will also have an important role alongside the managed care industry in developing and implementing solutions to confront emerging infections. Likewise, there are ample opportunities for academic health centers and government agencies to play the role of catalyst, as well as partner in research, for greater participation by managed care in addressing the public health threat of emerging infections.

A related common theme was the need for better information to support the provision of quality health care. For example, preliminary studies indicate that formulary practices may have an adverse impact on antibiotic resistance, prompting the need for additional comprehensive data on formulary practices and the impacts that drug formularies may have on infection control. The use of outcomes information was identified as one way of developing and implementing new clinical practice guidelines. One of the most promising fruits from the workshop discussion was the identification of the potential for integrated, computer-assisted medical information systems to assist physicians in diagnosing and treating infectious diseases; to assist managed care organizations in tracking antibiotic use, costs, and outcomes; and to assist public health agencies in monitoring and even preventing emerging infections and antibiotic resistance.

Many of the issues raised during the workshop, including both the use of drug formularies and surveillance, have international as well as domestic implications. In particular, it was explained that there are three health systems in Latin America—private, public, and employee systems—but that many of the providers in the region work with all three systems. As governments face increasing pressure to downsize, the impacts of that change on the vital public health functions of surveillance, control, and prevention of infectious diseases are a shared concern among all systems. In the United States, it is important to involve the National Institutes of Health, the Centers for Disease Control and Prevention, and private groups that are working on these issues in international deliberations. Unfortunately, it was noted that the subject of managed care was not part of the current White House foreign policy initiative in the area of infectious diseases. Nevertheless, the present discussion pointed to the need to bring the private sector into those deliberations in the future.



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