Adolescent health: a report to the U.S. Congress.

This article reports findings from an assessment by the Office of Technology Assessment (OTA), an analytical arm of the U.S. Congress.

Assessing information for consumers on the quality of medical care.

In recent years support for better public information on the quality of medical care has intensified, while the validity of the information available has been questioned. To address these concerns, we evaluated the reliability and validity of using each of 10 possible indicators to measure hospital and physician quality and the feasibility of providing the results to the public. We found that several of these indicators can provide useful, though not definitive, information on quality.

An analysis of methods to reform Medicare payment for physician services.

Congress and the administration are changing Medicare's method of paying for physician services, with the intention of reducing the growth in or absolute level of Medicare payment rates. We analyzed the implications of four possible strategies for payment reform: modifications to the present system of paying by customary, prevailing, and reasonable (CPR) charges; payment based on fee schedules; payment for packages of related services; and capitation payment. In some cases, improved quality or access may result.

Medicare coverage, Medicare costs, and medical technology.

One possible approach to containing Medicare costs involves explicit changes in Medicare's coverage policy with respect to medical technology. This paper first describes the development and diffusion of medical technology in general and then describes how technologies are identified, assessed, and approved for payment by Medicare. Currently, cost is neither a criterion nor an explicit issue in coverage decisions, although coverage policy is an integral part of payment policy.

The effect of economic incentives on the education and distribution of physicians: a review.

This paper examines the available evidence on the impact of economic factors on the specialty and locational choices of physicians. Economic variables which influence the "rate of return" to the physician (profitability in relation to training costs) to alternative specialties and locational decisions include average yearly income, hours of work, price for each health service and training costs. The findings of the review indicate that the rate of return to specialty training varies substantially among specialties.

A manpower policy for primary health care.

A National Academy of Sciences study of policy options for the supply of primary health-care manpower has produced a comprehensive set of recommendations. The study finds an adequate overall supply of physicians, but a shortage of primary health-care practitioners. It recommends maintaining current enrollment levels in medical schools and training programs for nurse practitioners and physician assistants and increasing the proportion of primary-care residents.