Division of Health Care Services – författare

"The Nation has lost sight of its public health goals and has allowed the system of public health to fall into ''disarray''," from The Future of Public Health. This startling book contains proposals for ensuring that public health service programs are efficient and effective enough to deal not only with the topics of today, but also with those of tomorrow. In addition, the authors make recommendations for core functions in public health assessment, policy development, and service assurances, and identify the level of government—federal, state, and local—at which these functions would best be handled.

The federal and state partnership in supporting immunization programs that benefit the general population evolved over the last half of the 20th century from a simple cost-sharing arrangement for vaccine purchase for disadvantaged children to a more complicated mix of programs, health care coverage benefits, and public-private partnerships. The mix of financial arrangements that support immunization efforts was the subject of a study by the Institute of Medicine, resulting in the publication of the report Calling the Shots. In June 2001, a group of 50 health officials, public health experts, health care providers, health plan representatives, and community leaders met at the University of Illinois in Chicago to explore the implications of the IOM findings and recommendations for the states of Illinois and Michigan. The one-day workshop was the first in a series of four meetings organized by IOM with support from the Centers for Disease Control and Prevention to foster informed discussions about future financing strategies for the public health infrastructure that supports immunization efforts.

This report of the Chicago workshop summarizes the findings of the IOM study and reviews the challenges that remain in establishing a reliable financial base for the U.S. immunization system. The report high-lights strategies presented by workshop speakers and discussants for achieving immunization goals, including increases in state and federal public health budgets, the addition of quality improvement measures in health plans, performance-based contracting, public policy actions, and the creation of public-private partnerships.

Calling the Shots examines the basic strategies that finance the national immunization system in the current health care climate. It is a comprehensive volume, rich with data and highlighted examples, that explores:

Calling the Shots will be an indispensable resource to those responsible for maintaining our nation''s vaccine vigilance.

The Social Security Administration (SSA) is engaged in redesigning its disability determination process for providing cash benefits and medical assistance to blind and disabled persons under the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program (Title II and Title XVI of the Social Security Act). The agency has undertaken a multiyear research effort to develop and test the feasibility, validity, reliability, and practicality of the redesigned disability determination process before making any decision about its national implementation.

Survey Measurement of Work Disability reviews and provides advice on this research. One of the major areas for review is the ongoing independent, scientific review of the scope of work, design, and content of the Disability Evaluation Study (DES) and the conduct of the study by the chosen survey contractor. This report identifies statistical design, methodological, and content concerns and addresses other issues as they arise.

Immunization is essential to disease prevention efforts in public health, but the U.S. health care system faces financial challenges that are affecting the delivery of immunization services. An earlier report from the Institute of Medicine (IOM), Calling the Shots: Immunization Finance Policies and Practices, pointed to the instability of the fundamental infrastructure that supports immunization programs throughout the United States, including growing financial burdens and operational complexities in immunization services, shortcomings in public- and private-sector investments in vaccine purchases and immunization programs, and fluctuations in insurance plans in the public and private health care sectors that create uncertainties regarding coverage of vaccine purchase and service delivery arrangements. In October 2001, a group of about 50 health officials, public health experts, health care providers, health plan representatives and purchasers, state legislative officials, and community leaders met at the Texas Medical Association in Austin to explore the implications of the IOM findings and recommendations for Texas. The 1-day workshop was the second in a series of four meetings organized by IOM with support from the Centers for Disease Control and Prevention to foster informed discussions about challenges for immunization finance and future strategies for strengthening immunization activities and the public health infrastructure that supports those activities.

This report of the Austin workshop summarizes the findings of the previous IOM report and reviews continuing challenges in immunization finance for the nation and for individual states, with a particular focus on Texas. The report also highlights strategies proposed by individual workshop participants that can be used to address those challenges. Several presenters and discussants emphasized that adequate funding is necessary for immunization programs but that financial resources alone are not sufficient to guarantee success. Similarly, they indicated that no single agency or group in the public or the private sector should expect, or should be expected, to solve immunization problems. Speakers from both public and private health agencies observed that collaboration, consultation, and partnership efforts across levels of government and between the public and private sectors are essential.

This report, which was developed by an expert committee of the Institute of Medicine, reviews the first three services listed above. It is intended to assist policymakers by providing syntheses of the best evidence available about the effectiveness of these services and by estimating the cost to Medicare of covering them. For each service or condition examined, the committee commissioned a review of the scientific literature that was presented and discussed at a public workshop.

As requested by Congress, this report includes explicit estimates only of costs to Medicare, not costs to beneficiaries, their families, or others. It also does not include cost-effectiveness analyses. That is, the extent of the benefits relative to the costs to Medicare—or to society generally—is not evaluated for the services examined.

The method for estimating Medicare costs follows the generic estimation practices of the Congressional Budget Office (CBO). The objective was to provide Congress with estimates that were based on familiar procedures and could be compared readily with earlier and later CBO estimates. For each condition or service, the estimates are intended to suggest the order of magnitude of the costs to Medicare of extending coverage, but the estimates could be considerably higher or lower than what Medicare might actually spend were coverage policies changed. The estimates cover the five-year period 2000-2004.

In addition to the conclusions about specific coverage issues, the report examines some broader concerns about the processes for making coverage decisions and about the research and organizational infrastructure for these decisions. It also briefly examines the limits of coverage as a means of improving health services and outcomes and the limits of evidence as a means of resolving policy and ethical questions.

The VA National Formulary generated controversy, which motivated congressional scrutiny and a directive to the VA to commission this report reviewing the experience with the National Formulary and formulary system. This Institute of Medicine committee was pleased to assist the Congress with this review, in part because the committee saw in the VHA example an opportunity to understand and anticipate problems that all publicly funded programs are likely to encounter in this new age of pharmaceuticals. The Congress asked the committee to review the restrictiveness of the National Formulary, its impact on the costs and quality of care in the VHA, and how it compared to formularies and drug management practices in the private sector and in other public programs, especially Medicaid. Detailed in the pages that follow, the committee''s findings and conclusions on these questions are, the committee believes, highly instructive, though not always in the ways that we anticipated.

In 1997, the Institute of Medicine published a report entitled Non-Heart- Beating Organ Transplantation: Medical and Ethical Issues in Procurement. The findings and recommendations of that study defined the ethical and scientific basis for non-heart-beating organ donation and transplantation, and provided specific recommendations for practices that affirm patient welfare, promote patient and family choice, and avoid conflicts of interest.

Following the 1997 study, the Department of Health and Human Services requested a follow up study to promote such efforts. The central activity for this study was a workshop held in Washington, D.C., on May 24-25, 1999. The workshop provided the opportunity for extensive dialogue on non-heart-beating organ donation among hospitals and organ procurement organizations (OPOs) that are actively involved in non-heartbeating organ and tissue donation and those with concerns about whether and how to proceed.

The findings and recommendations of this report are based in large measure on the discussions and insights from that workshop. Non-Heart-Beating Organ Transplantation includes seven recommendations for developing and implementing non-heart-beating-donor protocols. These recommendations were based on the findings and recommendations from the 1997 IOM report and consensus achieved among participants at the national workshop. The committee developed these recommendations as steps towards an approach to non-heart-beating-donor organ donation and procurement consistent with underlying scientific and ethical guidelines, patient and family options and choices, and public trust in organ donation.

The need for quality improvement and for cost saving are driving both individual choices and health system dynamics. The health services research that we need to support informed choices depends on access to data, but at the same time, individual privacy and patient-health care provider confidentiality must be protected.

Clinical laboratory tests play an integral role in helping physicians diagnose and treat patients. New developments in laboratory technology offer the prospect of improvements in diagnosis and care, but will place an increased burden on the payment system.

Medicare, the federal program providing coverage of health-care services for the elderly and disabled, is the largest payer of clinical laboratory services. Originally designed in the early 1980s, Medicare''s payment policy methodology for outpatient laboratory services has not evolved to take into account technology, market, and regulatory changes, and is now outdated. This report examines the current Medicare payment methodology for outpatient clinical laboratory services in the context of environmental and technological trends, evaluates payment policy alternatives, and makes recommendations to improve the system.

Calling the Shots examines the basic strategies that finance the national immunization system in the current health care climate. It is a comprehensive volume, rich with data and highlighted examples, that explores:

Calling the Shots will be an indispensable resource to those responsible for maintaining our nation''s vaccine vigilance.

The federal and state partnership in supporting immunization programs that benefit the general population evolved over the last half of the 20th century from a simple cost-sharing arrangement for vaccine purchase for disadvantaged children to a more complicated mix of programs, health care coverage benefits, and public-private partnerships. The mix of financial arrangements that support immunization efforts was the subject of a study by the Institute of Medicine, resulting in the publication of the report Calling the Shots. In June 2001, a group of 50 health officials, public health experts, health care providers, health plan representatives, and community leaders met at the University of Illinois in Chicago to explore the implications of the IOM findings and recommendations for the states of Illinois and Michigan. The one-day workshop was the first in a series of four meetings organized by IOM with support from the Centers for Disease Control and Prevention to foster informed discussions about future financing strategies for the public health infrastructure that supports immunization efforts.

This report of the Chicago workshop summarizes the findings of the IOM study and reviews the challenges that remain in establishing a reliable financial base for the U.S. immunization system. The report high-lights strategies presented by workshop speakers and discussants for achieving immunization goals, including increases in state and federal public health budgets, the addition of quality improvement measures in health plans, performance-based contracting, public policy actions, and the creation of public-private partnerships.

The Social Security Administration (SSA) is engaged in redesigning its disability determination process for providing cash benefits and medical assistance to blind and disabled persons under the Social Security Disability Insurance (SSDI) program and the Supplemental Security Income (SSI) program (Title II and Title XVI of the Social Security Act). The agency has undertaken a multiyear research effort to develop and test the feasibility, validity, reliability, and practicality of the redesigned disability determination process before making any decision about its national implementation.

Survey Measurement of Work Disability reviews and provides advice on this research. One of the major areas for review is the ongoing independent, scientific review of the scope of work, design, and content of the Disability Evaluation Study (DES) and the conduct of the study by the chosen survey contractor. This report identifies statistical design, methodological, and content concerns and addresses other issues as they arise.

A significant medical event is expected in 1992: the first human use of a fully implantable, long-term cardiac assist device. This timely volume reviews the artificial heart program—and in particular, the National Institutes of Health''s major investment—raising important questions.

The volume includes:

The committee also offers three mechanisms to aid in allocating research and development funds.

In 1997, the Institute of Medicine published a report entitled Non-Heart- Beating Organ Transplantation: Medical and Ethical Issues in Procurement. The findings and recommendations of that study defined the ethical and scientific basis for non-heart-beating organ donation and transplantation, and provided specific recommendations for practices that affirm patient welfare, promote patient and family choice, and avoid conflicts of interest.

Following the 1997 study, the Department of Health and Human Services requested a follow up study to promote such efforts. The central activity for this study was a workshop held in Washington, D.C., on May 24-25, 1999. The workshop provided the opportunity for extensive dialogue on non-heart-beating organ donation among hospitals and organ procurement organizations (OPOs) that are actively involved in non-heartbeating organ and tissue donation and those with concerns about whether and how to proceed.

The findings and recommendations of this report are based in large measure on the discussions and insights from that workshop. Non-Heart-Beating Organ Transplantation includes seven recommendations for developing and implementing non-heart-beating-donor protocols. These recommendations were based on the findings and recommendations from the 1997 IOM report and consensus achieved among participants at the national workshop. The committee developed these recommendations as steps towards an approach to non-heart-beating-donor organ donation and procurement consistent with underlying scientific and ethical guidelines, patient and family options and choices, and public trust in organ donation.

The need for quality improvement and for cost saving are driving both individual choices and health system dynamics. The health services research that we need to support informed choices depends on access to data, but at the same time, individual privacy and patient-health care provider confidentiality must be protected.

Clinical laboratory tests play an integral role in helping physicians diagnose and treat patients. New developments in laboratory technology offer the prospect of improvements in diagnosis and care, but will place an increased burden on the payment system.

Medicare, the federal program providing coverage of health-care services for the elderly and disabled, is the largest payer of clinical laboratory services. Originally designed in the early 1980s, Medicare''s payment policy methodology for outpatient laboratory services has not evolved to take into account technology, market, and regulatory changes, and is now outdated. This report examines the current Medicare payment methodology for outpatient clinical laboratory services in the context of environmental and technological trends, evaluates payment policy alternatives, and makes recommendations to improve the system.

The VA National Formulary generated controversy, which motivated congressional scrutiny and a directive to the VA to commission this report reviewing the experience with the National Formulary and formulary system. This Institute of Medicine committee was pleased to assist the Congress with this review, in part because the committee saw in the VHA example an opportunity to understand and anticipate problems that all publicly funded programs are likely to encounter in this new age of pharmaceuticals. The Congress asked the committee to review the restrictiveness of the National Formulary, its impact on the costs and quality of care in the VHA, and how it compared to formularies and drug management practices in the private sector and in other public programs, especially Medicaid. Detailed in the pages that follow, the committee''s findings and conclusions on these questions are, the committee believes, highly instructive, though not always in the ways that we anticipated.

The nation''s health care system has changed dramatically and the country is debating further significant changes. Comprehensive information is needed to guide policymakers in understanding and evaluating the current problems and in formulating federal health care policy.

This book contains an evaluation of the plan developed by the National Center for Health Statistics for restructuring its existing provider surveys. It identifies current and future data needed by researchers and policymakers to assess the effect of changes in financing, organization, and delivery of health care on access, quality, costs, and outcomes of care and determines the extent to which the design and content of the proposed survey can meet these data needs.

The book goes beyond a simple review and recommends a design framework to develop a coordinated and integrated data system to gather information about people and their illness over time and to link this information to costs and health care outcomes.

"The Nation has lost sight of its public health goals and has allowed the system of public health to fall into ''disarray''," from The Future of Public Health. This startling book contains proposals for ensuring that public health service programs are efficient and effective enough to deal not only with the topics of today, but also with those of tomorrow. In addition, the authors make recommendations for core functions in public health assessment, policy development, and service assurances, and identify the level of government—federal, state, and local—at which these functions would best be handled.