This paper represents the seventh in a continuing series of original brief papers prepared and published by the Office of Health and Medical Affairs to explore issues that have important implications for health policy in Michigan. Both the topics and the approach vary from paper to paper. Some address specific policy proposals: others are more general and explore issues that have relevance for a number of health policy questions. Some, but not all, include specific recommendations for changes in policy.

The objective of this series is to raise for discussion health policy questions which the Office thinks deserve attention by those concerned with health policy in the state. The hope is that the series will help inform and educate the public and policy-makers, will provoke reaction from others who have experience and expertise in health matters so that important issues will get a thorough examination, and will thereby ultimately help to improve health policy in Michigan.

We attempt to convey information in these papers in a form that is understandable and useful not only to people who are regularly involved in health care delivery, financing, and policy-making, but also to people who are unfamiliar with the jargon of the field and who have only a modest understanding of the way the industry operates.

The importance of focusing attention on health policy will be questioned by hardly anyone. The continuing escalation of health care costs in this state, as elsewhere, has caused critical fiscal problems for both the private and public sectors and has created intense pressures to find solutions. At the same time, no one would deny the importance of maintaining a health care delivery system that is accessible to all who need care and which provides consistently high quality services. It is imperative, therefore, that the policies that are developed be based upon careful reflection and a clear understanding of their implications for cost, quality, and access. We believe that this series of papers can contribute to that process.

Jay G. Endsley, Director

Office of Health and Medical Affairs

Department of Management and Budget

State of Michigan