Assessing the quality of care for children. Prospects under health reform
E. A. McGlynn, N. Halfon and A. Leibowitz
RAND, Santa Monica, CA, USA.
The failure to pass federal health reform legislation this year does not
mean that the health care crisis has been solved. As we look forward to
predictably more incremental efforts to reduce costs, increase access, and
improve quality, key issues from the most recent round of deliberations
will undoubtedly reemerge. In the last session of Congress, private and
public policymakers sent a clear signal that the era of accountability had
arrived. In the health reform bills that Congress considered last year, a
range of "measurement" strategies were put forth as essential elements for
achieving accountability in a reformed health care system. For example,
routine monitoring of the quality of care delivered by health plans and
health providers was viewed as necessary to balance the impact of policies
to control the cost of health care. Each of the major bills that were
introduced this past year--Gephardt/Mitchell (S 1757/HR 3600),
Cooper/Grandy (HR 3222), Breaux/Durenburger (S 1579), Nickles (S 1743),
Chafee/Thomas (S 1770/HR 3704), and Wellstone/McDermott (S 491/HR
1200)--and the mark-up bills that have emerged from Senate and House
committees have placed considerable emphasis on evaluating changes in
access to health care and quality of care. Although the bills addressed
issues related to financing, coverage, and the structure of the delivery
system quite differently, they demonstrated much more consensus with regard
to quality monitoring.
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