Assessing the quality of care for children. Prospects under health reform

The failure to pass federal health reform legislation this year does not mean that the health care crisis has been solved. As we look forward to predictably more incremental efforts to reduce costs, increase access, and improve quality, key issues from the most recent round of deliberations will undoubtedly reemerge. In the last session of Congress, private and public policymakers sent a clear signal that the era of accountability had arrived. In the health reform bills that Congress considered last year, a range of "measurement" strategies were put forth as essential elements for achieving accountability in a reformed health care system. For example, routine monitoring of the quality of care delivered by health plans and health providers was viewed as necessary to balance the impact of policies to control the cost of health care. Each of the major bills that were introduced this past year--Gephardt/Mitchell (S 1757/HR 3600), Cooper/Grandy (HR 3222), Breaux/Durenburger (S 1579), Nickles (S 1743), Chafee/Thomas (S 1770/HR 3704), and Wellstone/McDermott (S 491/HR 1200)--and the mark-up bills that have emerged from Senate and House committees have placed considerable emphasis on evaluating changes in access to health care and quality of care. Although the bills addressed issues related to financing, coverage, and the structure of the delivery system quite differently, they demonstrated much more consensus with regard to quality monitoring.