Information Needs Associated with the Changing Organization and Delivery of Health Care: Summary of Perceptions, Activities, Key Gaps, and Priorities. II. Project Context: Health System Change and Stakeholder Functions



  • There is widespread consensus among major private sector health leaders that the health care system is undergoing enormous changes. Change is driven heavily by the active role of large private purchasers in encouraging managed care and competition in an effort to contain costs. The health care system is still in transition and considerable geographic diversity is likely to remain. With health system change, the gaps in supply side data that predated these changes have only grown worse and seriously so.
  • Information needs of stakeholders both overlap and represent unique functions and responsibilities of diverse groups. Users of data can be thought of in terms of health care suppliers, health care customers, and the regulators/ policymakers at the federal, state and local levels.
  • Stakeholders’ needs for information can be divided into three types: (1) structural information on components of the health care system and their linkages; (2) the process of care, including administrative and clinical performance; and (3) policy relevant information on the effects of structure and process on policy-relevant outcomes and the implications both generally and for distinct constituencies.

Virtually all those we interviewed expressed a sense of the enormity of change in the marketplace and the span of its effects. There is wide agreement that the serious gaps in supply side data that predated these changes have only grown worse and seriously so. As Joseph Newhouse, chair of the Prospective Payment Assessment Commission, observed in our conversation, “Where isn’t there a data gap?”

The context for this paper is the existing work on changes in the health system. We review these changes, as well as information users and groups, and the current health system information needed to meet the functional responsibilities of the groups.  However, while functional responsibilities vary by user group, we identified many information needs that are common to all groups. Recognizing user perspectives helped us identify in our interviews why groups expressed specific data needs, even when the interviewee did not explicitly describe how their organizations’ functional responsibilities fueled their health system data needs and many of the needs served multiple functions and overlapping user communities.

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