National Issues in Science and Technology 1993 (1993) / Chapter Skim
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Toward More Effective Health Care Reform: Selected Issues from Reports of the Institute of Medicine
Toward More Effective Health Care Reform: Selected Issues from Reports of the Institute of Medicine
Pages 41-56
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IV TOWARD MORE EFFECTIVE HEALTH CARE REFORM Selected Issues from Reports of the Institute of Medicine NATIONAL ACADEMY OF SCIENCES INSTITUTE OF MEDICINE
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germane IOM reports is appended We stand ready to work with you and your colleagues as you not only strive to achieve universal access to appropriate care and to moderate the increase in health care expenditures but also seek to improve the health and well-being for all Americans.
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We believe that achieving effective change must include concrete steps to assure: that services are appropriate and effective, that universal access is actually accomplished, that resources are used efficiently to realize improvements in health status, that health care professionals are trained and deployed appropriately, and that better information is marshalled to improve performance. We also believe that performance improvements should be measured by advances in the health and wellbeing of Americans in addition to relief of the economic burden.
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quality assessment and improvement; the value of health care; special populations: children and pregnant women; and · health care data and information. These four topics, together with universal access and cost containment, are not the only objectives that a health care reform package ought to embrace.
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Any statement of this objective needs to proceed from a comprehensive definition of quality, such as that from our 1990 report: "Quality of care is the degree to which health services for individuals and populations increase the likelihood of desired health outcomes and are consistent with current professional knowledge." The main emphases in this definition on individual patients and populations, on health outcomes broadly defined, and on professional responsibility are significant and support a commitment to private care and personal choice. An explicit reform objective incorporating this definition will underscore that cost containment and extension of health insurance coverage are not the only measures of success in your program.
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Improving efficiency is, in our view, a significant step toward addressing the unfairness of our present health care system; making quality of care one of the core principles of your health care reform package thus promises to support the other critical aims of reform. Achieving these goals will require an effective quality oversight and monitoring capability that is external to health care provider organizations; it will also call for better internal capacities for providers to continuously improve the quality of the care they render.
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Several TOM reports suggest how we might obtain fuller information about the value achieved for different kinds of health care spending. Your health care reform plan should provide adequate support for effectiveness and outcomes research.
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SPECIAL POPULATIONS: CHILDREN AND PREGNANT WOMEN Universal access to health insurance, significant as it will be on ethical and practical grounds, does not equal access to health care. Thus, a thorough health care reform proposal must give attention to certain special groups (such as AIDS patients, the frail elderly, those with severe mental disorders, minorities, and the poor)
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Ample evidence exists that many areas of the country have too few primary care practitioners (doctors, nurses, dentists, and other health professionals providing primary care) and health clinics, that the nation's medical schools and graduate training programs continue to produce more specialists than primary care physicians, and that we train far too few mid-level practitioners such as certified nurse-midwives.
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better patient information to support clinical decisions; (2) improved management of care by making quality assurance procedures and clinical practice guidelines more accessible to health care professionals at the time and site of patient care; (3)
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If these indicators are tracked over time, then the nation will have a much better gauge of the effects of policies and programs intended to improve access. Because guaranteed universal coverage is a core principle of your reform plan, it seems to us imperative that your Administration put in place a means of monitoring progress and identifying other barriers to access that are not removed by extending health insurance coverage.
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The purpose of our suggestions and recommendations in this paper is to underscore the importance of other key elements of reform, without which, in our view, even the most well-conceived and well-implemented reform efforts may not realize their full potential. In our judgment, your Administration's plan should address quality assessment and improvement, the value of health care, special populations (especially children and pregnant women)
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1990c. Clinical Practice Guidelines: Directions for a New Program.
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