The purpose of the health care system must be to continuously reduce the impact and burden of illness, injury and disability, and to improve the health and functioning of the people of the United States.


The Advisory Commission on Consumer Protection and Quality in the Health Care Industry was established by Executive Order 13017, dated September 5, 1996, with an amendment made with Executive Order 13040, dated March 26, 1997 (see Appendices). The Commission was charged to advise the President on changes occurring in the health care system and, where appropriate, to make recommendations on how best to promote and assure consumer protection and health care quality. The Commission is governed by the provisions of Public Law 92-463, as amended, which sets forth standards for the formation and use of advisory committees.

The Commission is co-chaired by the Honorable Alexis M. Herman, Secretary of Labor, and the Honorable Donna E. Shalala, Secretary of Health and Human Services. It has 34 members drawn from a variety of backgrounds including consumers, business, labor, health care providers, health plans, State and local governments, and health care quality experts.

The Commission was asked to advise the President on changes occurring in the health care system and recommend measures as may be necessary to promote and assure health care quality and value, and protect consumers and workers in the health care system. In particular, the Commission was asked to:

On November 20, 1997, the Commission delivered its Interim Report to the President, entitled, "A Consumer Bill of Rights and Responsibilities." An Executive Summary of that report appears in the Appendices of this report. Copies of the Interim Report can be obtained by writing to

Consumer Bill of Rights, Box 2429, Columbia, MD 21045-1429, or by calling, toll-free, (800) 732- 8200.

During the course of its deliberations, the Commission and its Subcommittees held 10 public meetings in Washington, DC, Burlington, VT, and Chicago, IL. The Commission heard public testimony from more than 150 individuals; others have provided written testimony and other forms of advice and counsel.


During the course of its deliberations, the Commission relied on the work of four Subcommittees for the initial deliberations on key policy issues. The leaders of those panels deserve special praise for their work: Peter Thomas, Consumer Rights, Protections, and Responsibilities; Sheila Leatherman, Quality Measurement; Mary Wakefield, Creating a Quality Improvement Environment; and Sandra Hernandez and Gail Warden, Roles and Responsibilities of Public and Private Purchasers and Quality Oversight Organizations.

The Commission wishes to thank Executive Director Janet Corrigan, for providing us with expert policy direction, strategic advice, and organizational support. Our appreciation, too, to Deputy Director Richard Sorian, and Ann Page, Associate Director for Policy, for their policy analysis, management, and communication skills.

Special thanks to John Dicken and Elizabeth Docteur who, in addition to their role as analysts, planned and coordinated the meetings and the staff work for the Quality Improvement Environment and Quality Measurement Subcommittees and to Peter Nixon, Marilyn Park, and Karen Titlow for their analytical and writing skills.

The Commission is especially grateful to Edward (Chip) Malin for his sound advice and remarkable management skills. And we thank Mary Gerald and Zita Holly for their steadfast administrative contributions.

Elizabeth McGlynn and Marsha Gold produced commissioned papers that contributed significantly to Chapters One and Two of this report. Important contributions to other chapters were made by Tony Dreyfus, Kevin Haugh, Lisa Iezzoni, Richard Kronick, Virginia Riehl, and Sandeep Wadhwa.

The Commission expresses its sincere appreciation to the following elected officials for their testimony: Rep. Sherrod Brown (D-OH), Rep. Ben Cardin (D-MD), Gov. Howard Dean (D-VT), Rep. John Dingell (D-MI), Mark Green, Sen. James Jeffords (R-VT), Sen. Joseph Lieberman (D- CT), Rep. Charlie Norwood (R-GA), Rep. Marge Roukema (R-NJ), Rep. Bernie Sanders (I-VT), Rep. Pete Stark (D-CA), and Rep. Henry Waxman (D-CA).

The Commission also wishes to thank the following individuals for their expert testimony: Theresa Alberghini, G. Lawrence Atkins, Frederick Aurbach, Laura Avakian, Larry Bedard, Judith Bello, William Benson, Robert Berenson, Barry Bermingham, David Blumenthal, Peter Bouxsein, Randall Bovbjerg, Robert Brook, John Brumsted, Tracy Buckholz, Gary Carneal, Mark Chassin, Alfred Chiplin, Jordan Cohen, Peggy Connerton, Colleen Conway-Welch, Richard Curtis, Lauren Dame, Helen Darling, Richard Davidson, Karen Davis, Thomas Delbanco, Steve deMontmollin, Don Detmer, Allen Dobson, John Eisenberg, Mary Jane England, Ron Fair, John Fanning, Laurie Flynn, Mary Foley, Mary Foto, Scott Furst, Jon Gabel, Robert Galvin, Geoffrey Garin, Paul Ginsburg, Susan Gleeson, Jack Hadley, Sandra Harmon-Weiss, Paul Harrington, Kevin Haugh, Harry Hertz, Cathy Hurwit, Douglas Kamerow, Jeanne Keller, Deborah Klein Walker, David Lansky, Lucian Leape, Peter Lee, S. Robert Levine, Donald Lewers, Deborah Lisi-Baker, Scott Macey, Marc Machiz, Deborah Maiese, Bruce McIver, Michael McMullan, Gregory Morris, Josephine Musser, Woodrow Myers, Margaret O'Kane, Dennis O'Leary, Richard Platt, Ken Porter, Anya Rader, Richard Rettig, David Reynolds, David Richardson, Elizabeth Rolph, Rand Rosenblatt, Diane Rowland, Herbert Sacks, Robert St. Peter, William Sage, Susan Schulmerich, John Seffrin, Cary Sennett, Gail Shearer, Henry Simmons, Albert Siu, Helen Smits, Ralph Snyderman, Caroline Rossi Steinberg, Andrew Van de Ven, Bruce Vladeck, James Webster, John Wennberg, and Gail Wilensky.

These individuals offered public comment to the Commission during its hearings: Judith Baker, Bob Boland, George Bosl, Winifred Booker, Larry Boras, Laura Braun, Gerald Britton, Leigh Callahan, Michael Cannon, Patty Clark, Carol Clay, Marco Coronado, John Crosby, Justin Dart, Kathleen Fitzgerald, Larry Gelb, Muriel Glanthen, Bob Gris, Michael Grice, Sharon Guillett, Ida Helander, Henry Heffernan, Carol Johnson, Ann Kempski, Richard Koepke, Margaret Lavigne, Maureen Linihan-Howard, Frances Louis-Taylor, Dwight Marsh, Robert Mayer, William McNary, William Michael, Marie Michnich, Suzanne Mintz, Lori Moore, Jim Mortimer, Thair Phillips, Jim Pyles, Michael Rapp, Josef Reum, Don Riggin, Charlie Sabatino, Sandra Sands, Cheryl Schmidt, Fred Star, Jean Summerfield, Andy Van Kleunen, Myrl Weinberg, Kathleen Yosko, and Gemma Ziegler.

The Commission and its staff wish to recognize the assistance of the following individuals from the U.S. Department of Health and Human Services: William Benson, Brenda Black, Jason Block, Holly Bode, Deby Blum, Laurie Boeder, Peter Bouxsein, M. Blake Caldwell, Karen Carp, DonnaRae Castillo, Henry Chiu, Ken Choe, Carolyn Clancy, Gary Claxton, Mary Pat Couig, Venese DeJernett, Betsy D'Jamoos, Jackie Eder, Frances Eisel, John Eisenberg, John Fanning, Bernadette Fernandez, Stephen Finan, Myra Finkel, Nancy Foster, Geri Goins, Mary Grady, Mary Harahan, Howard Holland, Bruce Immerman, John Jones, Doug Kamerow, Jeff Kang, Michael Katz, Joyce Kelly, Marge Keyes, Mary Lambert, Lisa Lang, William LeVee, Adrienne Little, Margaret Long, Deborah Maiese, Renee McCullough, Ellen McGovern, Michael McMullan, Patricia MacTaggart, Tonya Manuel, Karen Migdail, Nancy Miller, Kevin Murray, Karen Norrell, Shana Olshan, David Peabody, Salina Prasad, Sandy Robinson, William Robinson, Mary Rolston, Lisa Rovin, Maggie Rutherford, Judy Sangl, Randie Siegel, Richard Silva, Stephanie Simons, Lisa Simpson, Anthony So, Joann Staton, Joan Steiber, Christopher Treston, Vicky Rivas Vasquez, Nancy Wartow, Judy Wilcox, Christine Williams, and Bill Wood.

We also thank the following individuals from the U.S. Department of Labor: Valerie Akers, Olena Berg, Bette Briggs, Mark Connor, Myra Dandridge, Cheryl Dorsey, Robert Doyle, Elizabeth Goodman, Mark Greenstein, Monica Healy, Richard Hinz, Susan Lahne, Alan Lebowitz, Gerald Lindrew, Avis McKnight, Mark Machiz, Daniel Maguire, Kevin Maroney, Meredith Miller, Holly Nelson, Kaye Pestaina, David Saltz, William Taylor, Sharon Watson, Alice Weiss, and Tiffany Williams.

Finally, the Commission acknowledges the assistance of the many individuals who have lent their expertise: Amy Anderson, Cybele Bjorklund, Carmella Bocchino, Howard Cohen, Steve Corrie, Gayle Dahlman, Geri Dallek, Diana Dennett, Paul Dennett, Molla Donaldson, Sam Downing, Amy Driskowski, Margaret Farrel, Marilyn Field, Linda Fishman, Karen Geiss, Lee Goldberg, Linda Headrick, Henry Heffernan, Jack Hoadley, Brent James, Chip Kahn, Jim Klein, Donna Koocher, Judith Lichtman, Brian Lindberg, Marjorie MaGinn, Mary Jo Malone, John McCarthy, Ned McCulloch, Catherine McDermott, Mary McDonald, Kathleen McGinley, Kathy Milholland, David Nexon, Elizabeth Noyes, Sheila Pasupathy, Karen Pollitz, Karl Polzer, Lisa Raines, Carol Regan, John Rother, Patricia Rowell, Cristen Schmitt, Reka Shinkle, Thomas Spangler, Nicole Tapay, Bridget Taylor, Bruce Taylor, Mark Ugoretz, Carol Vargo, Elizabeth Vega, Judy Waxman, Andrew Webber, Marina Weiss, Peters Willson, Lawrence Zippin, and many others.