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From The CriticsReviewer: Bryan E. Dowd, PhD (University of Minnesota School of Public Health)
Description: The book, presented in two parts, first reports the proceedings and findings of the Committee on Choice and Managed Care of the Institute of Medicine. The second, appendix section contains eight reports on related topics commissioned by the committee.
Purpose: The implied purpose of the book is to report on the proceedings and findings of the ten-member Committee's 12-month project to study ways to ensure public accountability and informed purchasing for Medicare beneficiaries.
Audience: The targeted audience appears to be primarily health policymakers, and secondarily, health plan administrators.
Features: Consumer information about providers and health plans has been an important, neglected and to some extent, intractable, topic in healthcare markets for many years. Increased enrollment in managed care has given the topic a recent boost in policymaking circles. The Committee and the participants in their symposium certainly are recognized experts in the field of consumer information and Medicare managed care. The book is appropriately illustrated. The references are current and pertinent. The commissioned articles might serve better as chapters than as appendixes.
Assessment: This is an interesting and informative book. The articles in the appendixes are well written and on the point. In fact, the articles are better than the first three chapters that include Overview, Symposium Summary, and Findings and Recommendations. Important points are omitted in those initial chapters: (1) Before HMOs, the idea that anyone or any organization was accountable for the health status of a group of people never received serious consideration; (2) Better information has costs as well as benefits, and the goal should be to balance marginal costs and marginal benefits; (3) We know more about quality of care in HMOs versus the FFS sector for the Medicare population than any other population. The principal information challenge associated with Medicare HMOs is disseminating the established finding that HMOs generally, and certainly for serious illnesses (e.g., cancer, stroke, AMI), provide better care at lower prices than the FFS sector. Nonetheless, the book provides perspectives from influential policymakers.