diseases by nonspecialists, and the shift from inpatient to outpatient treatment all raise concerns in terms of infectious disease prevention, control, and reporting. Additionally, managed care practices may increase the complexity of an infectious disease outbreak investigation and subsequent public health response. If such trends continue, the result may be lost opportunities to mitigate the impacts of infectious diseases. However, collaborations between the public health community and managed care industry can ensure that the public's health is protected and that the health care environment is increasingly managed with cost containment as a goal.
To help inform the debate about the consequences of health care restructuring on infectious disease control and to identify model systems that illustrate best practices, the Forum on Emerging Infections convened a workshop—the subject of this workshop summary—to identify, clarify, and solidify some of the current and potential best practices in managed care with respect to identifying and treating emerging infections. The workshop focused on five major areas of importance to infectious disease control that both shape and are shaped by the changing health care environment: (1) basic and clinical research, (2) clinical practice guidelines, (3) surveillance and monitoring, (4) education and outreach, and (5) drug formularies. Workshop participants outlined many of the challenges to be overcome and identified possible opportunities for addressing obstacles. A summary of these challenges and opportunities listed in the following sections were addressed and discussed by workshop participants. These challenges and opportunities, however, do not necessarily represent the views of either the Forum on Emerging infections or the Institute of Medicine.
Health care reform has changed the financial base upon which the modern academic medical center is structured. The cost-containment efforts of managed care organizations have reduced the institutions' net revenues from the provision of clinical care that have traditionally been used to support research and training. Concomitantly, the amount of time that faculty can spend conducting research and training future scientists and physicians has also been reduced, as the managed care system encourages physicians to treat more patients on a daily basis. Yet, in light of these changes, managed care can work with academic health centers to strengthen the foundation on which they conduct clinical investigations. Armed with large patient populations and centralized information systems, managed care organizations are uniquely positioned to partner their resources with the research infrastructure and culture offered by academic health centers. The following objectives related to conducting basic and clinical research in a managed care setting emerged during the workshop presentations and discussions and are described in greater detail in the workshop summary:
supporting the functions of academic health centers,