Assessing Health Care Reform (1993) / Chapter Skim
Currently Skimming:
Improving the Infrastructure for Effective Change
Improving the Infrastructure for Effective Change
Pages 51-70
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 52... ...
GOVERNANCE AND ADMIMSrRATION Different reform proposals involve vastly different and difficult-tocatalog levels and distributions of governance and administrative responsibilities. The committee does not talce a position on Me Ideas administrative structure for health care reform; that structure must be finked to the specifics of a particular proposal.
|
From page 53... ...
This should be simpler for some proposals, for example, Lose that call for automatic enrollment (e.g., at birch in a single national heath plan. Proposals that incorporate competitive health plans will have to identify how much uniformity and simplicity is desirable and feasible with respect to such matters as criteria or rules for monitoring the quality and appropriateness of services, tracking eligibility for coverage under different heaid1 plans, filing claims for payment, reporting information on outcomes, and using electronic data interchange technologies.
|
From page 54... ...
The monitoring and evaluation efforts will be essential elements of He phasing, and clear responsibilities for such longterm monitoring and research should be described. Ongoing program evaluation, although expensive and time consuming, provides Me knowledge to determine whether we are moving In the directions sought through beady care reform and to make appropriate mid course corrections in policies or their implementation.
|
From page 55... ...
Thus, steps taken today can be expected to have effects a quarter-century from now. Because a heals care reform plan is unlikely to replace totally this configuration of factors affecting capital, the committee believes Hat it Is critical for He reform plan to give explicit attention to both health personnel and physical capital policies that connect these important longterm inputs to the desired objectives of the reform plan.
|
From page 56... ...
The committee also notes that health care reform plans calling for major reconf~gurations of arrangements for services, such as He creation of new health care plans providing comprehensive services, will generate up-front capital requirements to pay for the costs of the necessary consolidations and reorganizations of providers. These initial investments in organizational capital will need to be financed out of He fixture stream of revenue.
|
From page 57... ...
for generalists and specialists and how the relevant education and training programs will be supported. The committee recommends that health care reform proposals describe police—and priorities that determine the role of various providers, including nurses and physicians, and the settings from which they should deliver care.
|
From page 58... ...
, and market forces responding to reimbursement policies have all been used. A heals care reform plan should be explicit about how it will influence investment in physical plants and equipment to be consistent with the fundamental goals of access, efficiency, and quality.
|
From page 59... ...
These should contain material on access to and availability of care, use of heath services and technologies, outcomes of care, demographic information, and information on health plans. These data can be used In health services, effectiveness, and outcomes research, technology assessments, and the evaluation of national and state health care reform efforts.
|
From page 60... ...
. Universal adoption of CPRs promises all the following: better patient information to support clinical decisions; improved management of care by making quality assurance procedures and coca practice guidelines more accessible to hemp care professionals at the time and site of patient care; reduced administrative costs; and more relevant, accurate data necessary for provider and consumer education, technology assessment, health services research, and related work concerning Be appropriateness, effectiveness, and outcome of care.
|
From page 61... ...
to a wide range of published and other information important to Pose who deliver health care and to those who produce and use heals semices research; promoting use of Me NEM's information services by a wider range of audiences and interest groups than has heretofore been He case; and expanding and enhancing the traditional reference, research assistance, coding, and retrieval activities of He library and its nations network of libraries. Although He committee does not expect reform proposals to deal wig these information technology and services issues in detail, it does express its hope that the need for and utility of the NEM's broad scope of activities will be recognized and supported at least in general terms.
|
From page 62... ...
With respect to He looming changes In health care delivery that reform promises, however, greater attention will have to be given to the cI=cal evaluation sciences, ~nclud~g outcome and effectiveness research, and to health services research. To provide this knowledge and analytic base, the committee recommends an absolute increase in the support for a range of research and information activities that should be carried out if reform Is to be implemented and evaluated satisfactorily, particularly in the areas of clinical evaluation sciences and health services research.
|
From page 63... ...
Therefore, for purposes of informing Me fills range of SE~nples of the questions that reform proposals generate in the area of health services research include: How will reforms affect access to care by different subgroups of Hose currently insured and uninsured? How will reforms affect total spending on health care, the rate of increase in expenditures, and specific factors that influence spending (e.g., new technology, and the purchase of less generous health coverage)
|
From page 64... ...
For these reasons, the committee recommends that steps be taken to improve the nation's capacity to execute effective technology assessments and that reform proposals be explicit about how they wall deal with the innovation and diffusion of health technologies. Questions about He impact of cost containment on the innovation, development, and diffusion of medical technologies can be expected to arise, so ideally reform packages ought to anticipate these issues even if they cannot at this early stage propose definitive plans for managing technological innovation and change aOM, l991g, 1992c)
|
From page 65... ...
By explicitly recognizing these important links, He reform proposal can avoid the unintended starvation of public health programs in tile competition with heals care reform for scarce public funds. OTHER INFRASTRUCTURE ISSUES Programs for Special Populations The earlier discussion of access noted that He needs of special populations may require targeted public programs.
|
From page 66... ...
The discussion below highlights points raised In TOM reports on quality of care and clinical practice guidelines. A major criticism of the current Item for t1~rminino m"Ai~at ~ ~~ v—_~ ^~^ ~_~& ~~ ~lW1~ liability is that it is not a reliable vehicle for screening out or rejecting unwarranted claims of malpractice.
|
From page 67... ...
It also believed that plaintiffs as well as defendants should be able to cite robust guidelines in their arguments. Malpractice and tort reform are complex issues that perhaps need not be woven directly into health care reform from the outset, although some committee members thought otherwise.
|
From page 68... ...
To educate individuals faced with malting decisions about possible courses of care for specific medical problems, clinical practice guidelines Hat consider outcomes relevant to patients and variations In patient preferences for different types of care and outcomes can—in He form of practitioner guidelines help physicians and over health care practitioners better educate patients and In the form of patient guidelines—help direcHy build patient understanding. New educational media such as the interactive video disc technology may at the same time standardize He information provided to patients and increase its relevance.
|
From page 69... ...
Any plan should make clear how it will deal with issues of human and physical capital supply and distribution. Health care reform proposals should describe policies and priorities Hat determine He role of various providers, including nurses and physicians, and the settings from which they should deliver care.
|
From page 70... ...
The committee also recommends adoption of an expanded program In information services for health services research and technology assessment at Be National Library of Medicine. The committee recommends an absolute increase in We support for a range of research and information activities Cat must be carried forth if reform activities are to be implemented and evaluated satisfactorily, particularly in He area of clinical evaluation sciences and health services research.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.