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January 18, 1995

Quality of Health and Health Care

Author Affiliations

From the Institute of Medicine, National Academy of Sciences, Washington, DC.

JAMA. 1995;273(3):244-245. doi:10.1001/jama.1995.03520270078039

The demise of federal efforts at health care system reform produced a number of losers. The non—Medicaid-eligible poor will continue to struggle for adequate access to appropriate health care, particularly preventive and primary care services. Academic health centers will be adversely affected by the unwillingness of managed care organizations to pay a significant portion of the research and education costs previously financed from patient care revenues. Many Americans will potentially be at risk because of the failure to create any national mechanism for adequate oversight and assessment of quality of care. Although many managed care organizations initially were established to improve the quality of care for their members and all of these organizations espouse a commitment to quality, the reality remains that a cost-driven system runs the risk of compromising quality, particularly for those least able to understand it or to assess it. With the return of the focus of

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