Millennium Health Care
David L. Bevett, BS, MPH
January 1, 1999
In recent years, the health system has undergone numerous shifts ranging from changes in
government policy and mandates to the development of new and innovative health care delivery
pathways. There has also been a transition from a local or regional focus to an increasingly national
perspective. A philosophical shift in health care funding has resulted in higher levels of accountability
for programs and organizations, a more community-focused approach, and a greater emphasis on
access, quality, and continuity of care. Management paradigms such as Total Quality Management
(TQM), policy research, and the integration of process and outcome evaluation in program planning
and evaluation evidence these trends. Underlying these shifts is a strong undercurrent for systems
change-a departure from the status quo model of a linked series of recoveries based on reaction to a
well-planned, coordinated response. The shift from the paradigm of reaction to response also
necessitates an evolution in perspective with an increased focus on planning and evaluation, and for
providing competitive, high quality, value-producing, and cost-effective services.
Evidence of current health care trends is provided by the increasing number of organizations focusing
on the research, development, and dissemination of planning, quality and evaluation tools and
materials. John M. Eisenberg, MD, Administrator, Agency for Health Care Policy and Research
(AHCPR) , states that "The rapid transformation and growing complexity of the health care
marketplace has created new challenges for health services research." The AHCPR's research
priorities include: 1. Effectiveness and outcome research; 2. Quality measure development; 3. Primary
care research; 4. Strengthening the evidence base for medical care, health market and related
organizational delivery changes; 5. Computer information technology applications; and 6. Health care
cost and financing. The mission of the Public Health Management Group, a Division of Public Health
Foundation Enterprises, Inc., City of Industry, California, is "to promote good health practices and
standards by encouraging the development and application of creative methods to advance the quality
of health care." The group's underlying goal is to build a healthier public health system by providing
administrative and operational services.
The challenges facing the publics’ health and the health care system are significant, and continue to
increase in both magnitude and complexity. The challenges reflect systemic multi-causal origins,
complicated vectors, and varying levels of impact on at-risk communities. Further, many of today’s
complex problems can not be addressed effectively through traditional methods alone. A more
integrated and comprehensive systems approach is required: systems problems require systems
solutions. This shift in paradigm will also require the identification and synthesis of the strengths,
strategies, and tools of both traditional and innovative methods. The resulting model will provide the
tools for change, and serve as the critical link to addressing existing and future challenges. Yet, to
effectively apply these tools for change, our thinking must reflect the fundamental knowledge that
each new challenge also represents an opportunity for transformation and change. As stated in
Healthy People 2000, “The beginning of the twenty-first century beckons with challenge and
opportunity for improved health of Americans. The year 2000 connotes change.” Change must
become more than what we do, it must become who we are, because the most critical and effective
technology for change exists in our minds.
David L. Bevett, BS, MPH
January 1, 1999
In recent years, the health system has undergone numerous shifts ranging from changes in
government policy and mandates to the development of new and innovative health care delivery
pathways. There has also been a transition from a local or regional focus to an increasingly national
perspective. A philosophical shift in health care funding has resulted in higher levels of accountability
for programs and organizations, a more community-focused approach, and a greater emphasis on
access, quality, and continuity of care. Management paradigms such as Total Quality Management
(TQM), policy research, and the integration of process and outcome evaluation in program planning
and evaluation evidence these trends. Underlying these shifts is a strong undercurrent for systems
change-a departure from the status quo model of a linked series of recoveries based on reaction to a
well-planned, coordinated response. The shift from the paradigm of reaction to response also
necessitates an evolution in perspective with an increased focus on planning and evaluation, and for
providing competitive, high quality, value-producing, and cost-effective services.
Evidence of current health care trends is provided by the increasing number of organizations focusing
on the research, development, and dissemination of planning, quality and evaluation tools and
materials. John M. Eisenberg, MD, Administrator, Agency for Health Care Policy and Research
(AHCPR) , states that "The rapid transformation and growing complexity of the health care
marketplace has created new challenges for health services research." The AHCPR's research
priorities include: 1. Effectiveness and outcome research; 2. Quality measure development; 3. Primary
care research; 4. Strengthening the evidence base for medical care, health market and related
organizational delivery changes; 5. Computer information technology applications; and 6. Health care
cost and financing. The mission of the Public Health Management Group, a Division of Public Health
Foundation Enterprises, Inc., City of Industry, California, is "to promote good health practices and
standards by encouraging the development and application of creative methods to advance the quality
of health care." The group's underlying goal is to build a healthier public health system by providing
administrative and operational services.
The challenges facing the publics’ health and the health care system are significant, and continue to
increase in both magnitude and complexity. The challenges reflect systemic multi-causal origins,
complicated vectors, and varying levels of impact on at-risk communities. Further, many of today’s
complex problems can not be addressed effectively through traditional methods alone. A more
integrated and comprehensive systems approach is required: systems problems require systems
solutions. This shift in paradigm will also require the identification and synthesis of the strengths,
strategies, and tools of both traditional and innovative methods. The resulting model will provide the
tools for change, and serve as the critical link to addressing existing and future challenges. Yet, to
effectively apply these tools for change, our thinking must reflect the fundamental knowledge that
each new challenge also represents an opportunity for transformation and change. As stated in
Healthy People 2000, “The beginning of the twenty-first century beckons with challenge and
opportunity for improved health of Americans. The year 2000 connotes change.” Change must
become more than what we do, it must become who we are, because the most critical and effective
technology for change exists in our minds.
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