In response to a request from the Secretary of the Department of Health and Human Services, the Institute of Medicine convened a committee to identify possible demonstration projects that might be implemented in 2003, with the hope of yielding models for broader health system reform within a few years. The committee is recommending a substantial portfolio of demonstration projects, including chronic care and primary care demonstrations, information and communications technology infrastructure demonstrations, health insurance coverage demonstrations, and liability demonstrations. As a set, the demonstrations address key aspects of the health care delivery system and the financing and legal environment in which health care is provided. The launching of a carefully crafted set of demonstrations is viewed as a way to initiate a "building block" approach to health system change.


Table of Contents


Front Matter
Executive Summary
1. The Time for Change Has Come
2. Chronic Care: Reducing the Toll of Chronic Conditions on Individuals and Communities
3. Primary Care: 40 Stellar Community Health Centers
4. Information and Communications Technology Infrastructure: A 'Paperless' Health Care System
5. State Health Insurance: Making Affordable Coverage Available to All Americans
6. Liability: Patient-Centered and Safety-Focused, Nonjudicial Compensation
Glossary and Acronym List