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Winter/Spring 2003 Vol. 3 No. 1

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©PhotoDisc Building Blocks to Health Care Reform

So many challenges face America's ailing health care system. The costs of health care are rising at an annual rate of 12 percent. The ranks of the uninsured swelled to 41 million in 2001. Doctors have gone on strike to protest exorbitant malpractice insurance rates. And medical errors continue to claim tens of thousands of lives each year.

In light of the many problems threatening to overwhelm the system, U.S. Secretary of Health and Human Services Tommy Thompson turned to the Institute of Medicine to help find solutions. Calling on its experts to offer "bold ideas," Thompson asked the IOM to propose a series of model projects that would test innovative approaches to some of the most serious problems.

In a new report, an IOM committee chose five key areas that, with proper attention, would offer the greatest potential for catalyzing further improvements. "Targeted demonstration projects in these areas can serve as a starting point, the planting of seeds of innovation that will grow into a robust 21st-century health care system," said committee chair Gail Warden, president and CEO of the Henry Ford Health System in Detroit.

One of the selected strategic areas is harnessing information technology to create a "paperless health care system." The health care sector has lagged behind virtually all other industries in adopting information technology, which could be applied to areas such as clinical record keeping and decision-support systems. The report calls for eight to 10 communities initially -- and another 25 follow-on sites -- to develop secure information systems that provide patients, care providers, and other authorized users with immediate access to computer-based patient records and the ability to exchange information electronically.

Health care has experienced a notable shift from treatment of mostly acute, episodic cases, such as broken bones or food poisoning, to managing a rising tide of chronic illnesses that can persist over years. The committee proposed that 10 to 12 demonstration projects should be undertaken to develop care programs for patients with chronic conditions and establish community-wide health promotion and prevention strategies to curtail the rapid increase of chronic disease.

At the same time, basic primary care in America frequently does not give patients the level and quality of care they deserve, the committee noted. A set of about 40 community health centers would provide an ideal testing ground to reinvent primary care. The centers should be encouraged to experiment with new, systematic approaches that would encompass acute, chronic, and preventive care.

The committee also took on the thorny issue of medical liability. Its proposed solution is a non-judicial compensation system that would promote more timely payments and the acknowledgement of error to a greater number of patients. Reasonable ceilings should be put on the providers' liability, but in exchange, providers would have to develop systems for reporting errors so that they can be analyzed and reduced.

Of course, to enjoy any benefits from these reforms, patients must have access to care. Millions of Americans currently have no health insurance, which severely hinders their ability to get care. The committee urged that three to five states conduct projects aimed at making affordable coverage available to all residents through tax credits to the uninsured to help offset coverage premiums, expanded eligibility for existing public coverage programs, or a combination of the two. Whereas the other demonstration projects are expected to be budget-neutral over time, extending health coverage would require significant, ongoing influxes of funds. A minimum commitment of 10 years is necessary to alleviate this intractable problem, the committee added.

Fixing the broken health care system will require significant resolve and commitment from both the public and private sectors. The committee hopes that its demonstration projects will prove to be the transforming building blocks that lead to significant improvements for all patients. "Nobody says it will be easy," Warden said. "However, the time for change is now."   -- Christine Stencel

Fostering Rapid Advances in Health Care: Learning from System Demonstrations. Committee on Rapid Advance Demonstration Projects: Health Care Finance and Delivery Systems, Board on Health Care Services, Institute of Medicine (2002, 108 pp.; ISBN 0-309-08707-4; available from the National Academies Press, tel. 1-800-624-6242; $35.00 plus $4.50 shipping for single copies).

The committee was chaired by Gail Warden, president and CEO of Henry Ford Health System, Detroit. The study was sponsored by the Institute of Medicine and the National Academy of Sciences.

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Copyright 2003 by the National Academy of Sciences