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Journal Issue: Health Care Reform Volume 3 Number 2 Summer/Fall 1993

Statement of Purpose
Richard E. Behrman

Statement of Purpose

The primary purpose of The Future of Children is to disseminate timely information on major issues related to children's well-being, with special emphasis on providing objective analysis and evaluation, translating existing knowledge into effective programs and policies, and promoting constructive institutional change. In attempting to achieve these objectives, we are targeting a multidisciplinary audience of national leaders, including policymakers, practitioners, legislators, executives, and professionals in the public and private sectors. This publication is intended to complement, not duplicate, the kind of technical analysis found in academic journals and the general coverage of children's issues by the popular press and special interest groups.

Reform of the health care system takes on a special significance with regard to children. Not only does their good health or lack of it affect them as individuals and their families, but their health status has a "multiplier effect" on the future productivity and well-being of our democratic society. In the Winter 1992 issue of The Future of Children, we examined how the existing U.S. health care system was working to serve the needs of children, youth, and pregnant women. In this issue of The Future of Children, we examine how to make the overall process of reforming the health care system work for the benefit of children. It is important that changes made in the way medical care is provided and financed under a reformed system not result in a reduction in the quantity or quality of services available to children. We have attempted to examine these issues objectively from multiple perspectives in a format that is accessible to a broad readership. The Recommendations and Analysis, authored by the staff of the Center for the Future of Children, draws from these articles and from our own research and deliberations.

In the competition among various reform proposals, discussion has focused primarily on various systemic issues of organizing and financing health care, and these are the focus of the articles included in the journal. However, it is also important for policymakers to appreciate some important distinctions about illness in children in comparison with adults because of the relevance of these distinctions to the way in which the reformed system will function at the interface of patient and health care provider.

From the point of view of the individual patient of any age, the quality of medical care depends to an important degree on the provider's understanding of the distinctive characteristics of each patient's response to illness and treatment as well as the need to generalize from experience with other patients. In children, the fact that they are in a continuing state of development and that serious illness occurs relatively infrequently compounds this problem of variability. In addition, aberrations in the developmental processes may themselves result in illness. Further, these processes are particularly sensitive to environmental influences such as the significant developmental regression of infants and young children that may occur with hospitalization if a parent does not "room-in" or appropriate alternative adult nurturing arrangements are not provided. Even moderately severe illness and related morbidity may be ameliorated or exacerbated by environmental factors and interventions, as well as by medical treatments.

These issues of variability and development are relevant to the medical care of most children, who enter the health care system with common acute illnesses and a need for preventive services. They are also relevant to the very small proportion of children having severe life-threatening illnesses or serious morbidity that may compromise their development and ability to function and may require extended, even lifetime, care. Policymakers should not lose sight of the fact that one of the most important purposes of a reformed health care system is to improve the services provided to children having this broad spectrum and distinctive character of individual health problems.

We invite your comments and suggestions as you read this issue of The Future of Children. Our intention is to encourage informed debate about health care reform and related issues. To this end we invite correspondence to the Editor. We would also appreciate your comments about the approach we have taken in presenting the focus topic and welcome your suggestions for future topics.