Oral

The ninth essential service of public health calls on the public health community to “evaluate the effectiveness, accessibility, and quality of personal and population-based health services.” Yet, the separation between public health and health care has been almost complete. The public health community has not participated in assessing the quality of health care or contributed to a vision of coherent reform. Studies have documented dramatic variation in medical care across states and regions, yet there is little relationship between the medical care delivered and its outcome. Ironically, the amount—and cost—of care received is inversely related to positive outcomes. Observers agree that a widening gap exists between the promise of advances in the science and the effectiveness of the health care system at improving population health. This session focuses on how policies, politics, and economics of the health system in both the public and private sectors have led to the current crisis in health care. Dr. Fisher will review evidence on geographic and health-system variations in practice; the relationship between spending on personal health care services and quality and outcomes of care; and implications for practice, policy, and payment reform. Dr. McClellan will review federal and private sector efforts to increase accountability through performance measurement and payment reform initiatives—and the promise for redirecting the delivery system from an emphasis on delivering services to improving health. Dr. Bigby will describe health care reform initiatives at the state level and challenges facing the public sector to effectively promote and improve population health.

Session Objectives: Understand geographic variation in the quality and outcomes of health services and how this variation relates to the ninth essential service of public health. Describe the patterns of variation in how medical care is provided across different regions in the U.S. Name three characteristics of local health systems that are associated with variations in use, cost and outcomes. Understand the relationship between higher Medicare spending and lower rates of provision of preventive health services. Describe the challenges of health reform from the Federal and State health levels.

CE Credits: CME, Health Education (CHES), Nursing