Constraining the rapid escalation of health care costs while extending health insurance coverage to all—the primary objectives of health care reform—will require significant improvements in the performance of our system for health care. This performance imperative is especially important because some of the factors behind rising health care expenditures, such as the aging of the population, are external to the health care system.
In the Preamble to this report, we set forth the committee's view that the fundamental goals of reform are to maintain and improve health and well-being, to make basic health coverage universal, and to encourage the efficient use of limited resources. The preceding sections of this document have provided a broad framework for assessing whether and how different reform proposals would pursue these goals. The elements of that framework—extending access to health care, containing health care costs, assuring quality of care, financing reform, and improving the infrastructure for effective change—all need to be addressed if system performance is truly to be improved. In some areas, we have made specific substantive recommendations based on the work of other IOM committees or the clear consensus of this committee; in other areas, we have laid out questions that proposals should answer.
A long-term perspective is essential. A framework for assessing reform, such as that we have suggested, will be useful both for the initial evaluation of proposals and for the assessment of progress over time. Indeed, to be most useful, as the results of reform efforts unfold the
committee's recommendations should be subject to the same type of ongoing evaluation as the reforms themselves.
The complexity of the health care system—and of health itself—presents major challenges to reform, and these challenges are intensified by the many important and often contending interests that have a stake in both the broad directions and intricate details of policy change. Reform proposals that focus primarily on financial issues and goals without recognizing that improved performance requires significant changes in how health care is organized and provided are unlikely to achieve the goals outlined here. Reform proposals must indicate their general approach to questions such as how health care professionals are to be appropriately trained and deployed (including expected responses to market signals from revised incentives), how better information is to be marshalled to improve performance, and how quality of care can be maintained and improved within resource constraints.
Finally, the reform of our health care system should be undertaken in the same spirit of continuous improvement and renewal that has so often been the keystone of success in America. The profound changes required for effective reform, even when the nation builds on the existing strengths of its health care system, demand that we learn from experience. To do that we need good information and sound analyses of results, flexibility and creativity in responding to that information, and an abiding focus on the concerns of the people whose health and well-being we seek to improve.