Information Needs Associated with the Changing Organization and Delivery of Health Care: Summary of Perceptions, Activities, Key Gaps, and Priorities. D. Assessing Issues and Needs: Outcomes of Delivery and Policy


Information on outcomes of the health care system have historically been among the least developed. In today’s environment, this kind of information is increasingly valued both by those concerned with assessing the value of care and by those concerned with understanding its costs and distributional implications. Table 5 summarizes questions in each of these areas that were raised in our interviews.


A. Appropriateness of Care and Clinical Outcomes

  • Who is controlling the process of care and are the entities doing it doing an appropriate job or are they too restrictive?
  • How can we assess changes in performance by distinguishing between effects of changes in medical practice versus access?
  • What are the clinical outcomes of care? the risk adjusted outcomes?
  • What are the resources that contribute to these outcomes? That is, how much is spent for given outcomes or types of patients or effects?
  • How do consumers assess outcomes of care in making decisions, considering appropriateness, cost, perceptions, etc.?

B. Costs of Care

  • Is bigger better in terms of the scale of enterprise?
  • What resources are devoted to ambulatory care?
  • How much is spent on physician care? on provider subgroups?
  • To what extent are system savings a one time only savings versus continuing savings? A function of price discounts or real changes in the mix, intensity, or quality of care? Have we now gone beyond the fat to the meat in cutting costs?

C. Population-Based Access and Distribution

  • How will we know if people are being squeezed out of the system? For example, what about the homeless? How do we interpret bad debt?
  • Can we assume people get needed care once they are insured and affiliated with a provider?
  • What is the value (community benefit) of a nonprofit institution or system?
  • What is the relationship between managed care and the public health infrastructure?

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