For the Public Good Highlights from the Institute of Medicine, 1970-1995 (1995) / Chapter Skim
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COMMENTARIES
COMMENTARIES
Pages 53-62
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From page 53... ...
Besides the rapid pace of technological invention, perhaps the most important progressions dunng the quarter-century under review have been in the social commitment to paying for health care; in the more organized ways of delivering it; and as the power of payers and purveyors has grown, in the greater attention of consumers to their own interests. To all of these, the TOM has been responsive.
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From page 54... ...
On the one hand, as efforts to control costs gain dominance, there is a temptation to skimp on some important aspects of care, of which attention to the niceties of care, so cherished by consumers, is perhaps the most vulnerable. On the other hand, as care is shifted to less equipped, less supervised sites, the threat to quality is bound to grow unless special efforts are made to anticipate the danger.
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From page 55... ...
Concerning the more fundamental concepts of quality in health care, it seems that the issues that call for greater attention are the means for bringing about greater, more informed participation by patients in decisions concerning their own care; a better understanding of the implications of the cost-benefit balance to public policy and the behavior of individual practitioners; and the pursuit of equity, with its attendant implications. As of now, we do not even have a near-complete understanding of how various cost control initiatives have influenced the quality of care in its subtler aspects.
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From page 56... ...
As such, its undoubted sensitivity to consumer interests is fiduciary, in the best traditions of the health care professions. Would the next step be an actual partnership with consumers, as equals, in 56
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From page 57... ...
More directly germane to quality assurance, we have, by and large, failed to involve consumers in the process of performance review itself. Moreover, consumers, as a whole, need authoritative, unbiased information so as to participate more intelligently in the public debate on health care policy.
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From page 58... ...
Director, RAND Health Sciences Program, and Professor of Medicine and Health Services, UCLA Center for Health Sciences If the 1994 U.S. elections are a marker of things to come, transformation of the health care system using the competitive marketplace as a mode} will likely be pushed forward.
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From page 59... ...
The medical directors' willingness to agree with this conclusion was facilitated, if not made possible, because a prestigious IOM committee, representing various points of view, had developed and agreed upon the way in which good primary care could be identified. The prestige attached to the TOM's committee process made the critical research results, which were based on recommendations in the report, acceptable to clinicians who wanted to improve quality of care in their own practices.
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From page 60... ...
Thus, after 25 years of committee-based work in the quality-ofcare field that has been dictated largely by the interests of external funders, the TOM needs to ask itself, "How can the Institute ensure that the quality of health care improves rather than deteriorates under various health system reforms? " and "How can the TOM help reduce the variation in quality of care by gender, race, socioeconomic class, and hospital or provider?
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From page 61... ...
Only by answering such questions can we demonstrate the value added by TOM's committee-based approach to its work in maintaining and improving the quality of health care in the United States. THE PAYOFF TO IMPROVING THE COMMITTEE STRUCTURE As the IOM celebrates its 25 years of exceptional contributions to the field of quality of care, ~ hope its membership takes the time to ensure that, during the next 25 years, the TOM can issue even better, and more timely, products that wit!
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From page 62... ...
1978. A Manpower Policy for Primary Health Care.
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