ASSESSING THE QUALITY OF CARE FOR CHILDREN - PROSPECTS UNDER HEALTH REFORM

The failure to pass federal health reform legislation this year does n ot mean that the health care crisis has been solved. As we look forwar d to predictably more incremental efforts to reduce costs, increase ac cess, and improve quality, key issues from the most recent round of de liberations 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 c onsidered last year, a range of ''measurement'' strategies were put fo rth as essential elements for achieving accountability in a reformed h ealth care system. For example, routine monitoring of the quality of c are delivered by health plans and health providers was viewed as neces sary to balance the impact of policies to control the cost of health c are. Each of the major bills that were introduced this past year-Gepha rdt/Mitchell (S 1757/HR 3600), Cooper/Grandy (HR 3222), Breaux/Durenbu rger (S 1579), Nickles (S 1743), Chafee/Thomas (S 1770/HR 3704), and W ellstone/McDermott (S 491/HR 1200)-and the mark-up bills that have eme rged from Senate and House committees have placed considerable emphasi s on evaluating changes in access to health care and quality of care. Although the bills addressed issues related to financing, coverage, an d the structure of the delivery system quite differently, they demonst rated much more consensus with regard to quality monitoring.