THE ROLE FOR REGIONAL AUTOPSY CENTERS IN THE EVALUATION OF COVERED DEATHS - SURVEY OF OPINIONS OF US AND CANADIAN CHAIRS OF PATHOLOGY AND MAJOR HEALTH INSURERS IN THE UNITED-STATES

Objective.-To evaluate the advantages and disadvantages of, as well as the attitudes of health care professionals and insurers toward, the d evelopment of regional autopsy services. Design.-Survey of 150 medical school departments of pathology in the United States and Canada slid 12 representative major health insurers in the United States. Results. -Of the 25 respondents from the pathology departments, most were in fa vor of regionalization of autopsy services, if properly underwritten. Of the five respondents from the health insurers, most were disinteres ted in the autopsy as a measure of outcome and unwilling to provide su pport. Conclusions.-Health care is being regionalized around networks of insurers rather than hospitals. The networks are defined by a mixtu re of hospitals, physician groups, and other health care professionals . Within networks, the goal is to subscribe groups of patients, covere d lives, for all medical needs from primary to complex care. As the ec onomic risk of caring for patients is shifted to physicians, the incen tive to provide service at the lowest possible cost grows, as-does the need to assure that medical mismanagement does not occur. To provide quality care at affordable costs, it is necessary that outcomes, inclu ding deaths, be professionally evaluated. The present system of death investigation involves hospital colleagues and is potentially biased. Regional autopsy centers that provide timely expert information should be part of the health care system. Medical schools are potential site s for regional autopsy programs because they have the personnel needed to conduct appropriate death-related studies. Most schools are affili ated programmatically and economically with surrounding hospitals and physicians in a manner in which outcomes, costs, and quality of clinic al service are of common interest.