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REPORT OF A STUDY
Health Services
Research
NAT1ONAE
ACADEMY of
SCIENCES
Washington, D.C. 1979
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NOTICE
This is the report of a project undertaken with the approval of the
Governing Board of the National Research Council, whose members are
drawn from the Councils of the National Academy of Sciences, the
National Academy of Engineering, and the' Institute of Medicine. The
members of the committee appointed to conduct the project and prepare
the report were selected for recognized competence and with due
consideration for the balance of disciplines appropriate to the
project.
This report has been reviewed by a group other than the authors
according to procedures approved by a Report Review Committee con-
sisting of members of the National Academy of Sciences, the National
Academy of Engineering, and the Institute of Medicine.
Supported by a contract from the Office of Science and Technology
Policy, Executive Office of the President of the United States.
The Institute of Medicine was chartered in 1970 by the National Academy
of Sciences to enlist distinguished members of medical and other pro-
fessions for the 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 advisor to the
Federal Government, and its own initiative in identifying issues of
medical care, research, and education.
IOM Publication 78-06
Library of Congress Catalog Card Number 79-84281
International Standard Book Number 0-309-02875-2
Available from
Office of Publications
National Academy of Sciences
2101 Constitution Avenue, N.W.
Washington, D.C. 20418
Printed in the United States of America
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INSTITUTE OF MEDICINE
COMMITTEE ON HEALTH SERVICES RESEARCH
Chairman
Robert H. EBERT, M.D., President, Milbank Memorial Fund, New York
Members
.
Leonard W. CRONKHITE, Jr., M.D., President, The Medical College of
Wisconsin, Milwaukee
Robert L. EICHHORN, Ph.D., Professor of Sociology and Director of the
Health Services Research Program, Purdue University, Lafayette
Scott FLEMING, Senior Vice President, Kaiser Plan Medical Care Program,
Oakland
Jacob GETSON, Assistant Commissioner, Department of Public Health,
Boston
Jay GOLDMAN, D.Sc., Professor and Chairman, Department of Industrial
Engineering, University of Missouri-Columbia, Columbia
Robert J. HAGGERTY, M.D., Director, General Pediatrics Academic Develop-
ment Program, Robert Wood Johnson Foundation, Children's Hospital
Medical Center, Boston
James G. HAUGHTON, M.D., Executive Director, Health and Hospitals Govern-
ing Commission of Cook County, Chicago
Barbara S. HULKA, M.D., Professor, Department of Epidemiology, University
of North Carolina at Chapel Hill, North Carolina
Herbert E. KLARMAN, Ph.D., Professor of Economics, Graduate School of
Public Administration, New York University, New York
Paul A. MARKS, M.D., Vice President for Health Sciences and Professor of
Human Genetics and Development, Columbia University, New York
David MECHANIC, Ph.D., Professor of Sociology, University of Wisconsin,
Madison
e · -
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Frederick MOSTELLER, Ph.D., Professor of Mathematical Statistics and
Chairman, Department of Biostatistics, Harvard University, Boston
Alan R. NELSON, M.D., Internist, Salt Lake City
Daniel W. PETTENGILL, West Hartford, Connecticut
Donald C. RIEDEL, Ph.D, Professor and Chairman, Department of Health
Services, University of Washington, Seattle
Kerr L. WHITE, M.D., Deputy Director, Division of Health Sciences,
Rockefeller Foundation, New York
iv
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INSTITUTE OF MEDICINE
DAVID A. HAMBURG, M.D., President
Division of Health Care Services
STUDY OF HEALTH SERVICES RESEARCH
Staff
Thomas W. BICE, Ph.D., Study Director, Deputy Director, Institute for
Health Care Studies, United Hospital Fund of New York, New York*
Linda K. DEMLO, Ph.D., Director, Division of Health Care Services,
Institute of Medicine, National Academy of Sciences, Washington, D.C.
Barbara BUCKLEY, Administrative Secretary, Institute of Medicine,
National Academy of Sciences, Washington, D.C.
Paul CAMPBELL, M.S., Professional Associate, Institute of Medicine,
National Academy of Sciences, Washington, D.C.
Peter E. DANS, M.D., Senior Professional Associate, Institute of
Medicine, National Academy of Sciences, Washington, D.C.
Richard M. SCHEFFLER, Ph.D., Director, Division of Health Manpower and
Resources Development, Institute of Medicine, National Academy of
Sciences, Washington, D.C.
Wallace K. WATERFALL, Director, Office of Communications, Institute of
Medicine, National Academy of Sciences, Washington, D.C.
Karen WINTRINGHAM, M.H.A., Research Assistant, Institute for Health Cars
Studies, United Hospital Fund of New York, New York
*Currently Professor, Department of Health Services, University of
Washington, Seattle
v
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