Future directions for the Agency for Health Care Policy and Research.

The Agency for Health Care Policy and Research (AHCPR) plays a leading role in health services research. Research efforts to develop practice guidelines, outcomes research, and computer applications have led to improvements in the delivery of care and reduced health care costs. These efforts aid consumers, providers, purchasers, and policy makers in health care decision making. This article cites numerous examples of AHCPR's efforts to increase quality of care and reduce costs.

The outcome for AHCPR. Interview by Laura Lynn Brown.

In late July, a House Appropriations Subcommittee voted to cut the Agency for Health Care Policy and Research (AHCPR) budget by 21 percent in fiscal year 1996. The six-year-old, $162 million agency has produced clinical practice guidelines for 10 of the 15 costliest conditions for which people are hospitalized. Their application has saved the health system far more than AHCPR costs, many experts believe. The agency's supporters say its work is a critical underpinning of the movement in value-based purchasing and quality assurance, while many Congressional Republicans believe the private sector could do AHCPR's work just as well. Health Systems REVIEW recently spoke with AHCPR administrator Clifton R. Gaus about the agency's mission and its strategy for survival.

Contrasts in HMO and fee-for-service performance.

This study compares various aspects of HMO performance in 10 plans with that of the fee-for-service system for the Medicaid population. Additionally, it examines utilization differences between several types of HMO's, grouped according to organization and provider payment. Four areas of behavior were studied--enrollment selectivity, utilization of services, accessibility of care, and satisfaction. The only significant difference between the two systems was in hospital utilization. Group-practice MNO's had significantly lower hospital utilization than the fee-for-service groups: foundation HMO's did not. This difference seems to indicate that capitation payment to an HMO alone is not significant enough to produce major changes in utilization and that the organized multispecialty group-practice arrangement with largely salaried physicians may be more significant. For the other variables--previous health status, ambulatory-care use (including preventive care), accessibility, and satisfaction--the two groups were remarkably similar.