Since 1973, the IOM, with funding from the Robert Wood Johnson Foundation, has directed the RWJ Health Policy Fellowships Program, which is designed to develop the capacity of outstanding mid-career health care professionals in academic and community-based settings to assume leadership roles in health policy and management. Each year, six fellows are selected to participate in a 1-year program of orientation and full-time work experience in the nation's capital. As part of their working assignment, fellows usually select work for a member of Congress or a congressional committee office where they play a senior role in developing health legislation and policy. Over the years the work of RWJ fellows on Capitol Hill has been praised for contributing valuable clinical and health sciences expertise to the legislative process (Breaux, 2000). The workshop dialogue, moderated by Lynn Etheredge, a nationally respected health policy analyst, focused on nine case studies covering a broad range of policy issues (Appendix B contains descriptions of the case studies approved by each speaker.). The rich discussion yielded several observations regarding unintended consequences in general, and consequences of specific health policy programs in particular.

Contents

• THE NATIONAL ACADEMIES
• REVIEWERS
• FOREWORD
• Unintended Consequences of Health Policy Programs and Policies
  • Background and Overview
  • A Long View: The Value of Historical Perspective
  • Medicaid
  • Assessing Risks and Regulating Benefits
  • Delivery System Restructuring
  • Lessons Learned
  • References
• APPENDIXES
  • APPENDIX A AGENDA
  • APPENDIX B Abstracts of Commissioned Papers on Unintended Consequences
  • APPENDIX C PARTICIPANT LIST
• Wendy B.Young, R.N., Ph.D.
• The Robert Wood Johnson Health Policy Fellowships Program

Support for this project was provided by The Robert Wood Johnson Foundation. The views presented in this report are those of the Institute of Medicine and are not necessarily those of the funding agencies.

NOTICE: The project that is the subject of this report was approved by the Governing Board of the National Research Council, whose members are drawn from the councils of the National Academy of Sciences, the National Academy of Engineering, and the Institute of Medicine. The members of the committee responsible for the report were chosen for their special competences and with regard for appropriate balance.