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Over the past three years, the U.S. Department of Health and Human Services (HHS) has made significant investments in state and local public health in an effort to enhance public health emergency preparedness. The RAND Corporation was contracted to work with the HHS Office of the Assistant Secretary for Public Health Emergency Preparedness (OASPHEP) to develop resources and to prepare analyses to help describe and enhance key aspects of state and local public health emergency preparedness. As part of this contract, RAND was asked to study the response of state and local health departments to recent disease outbreaks -- specifically, Severe Acute Respiratory Syndrome (SARS), monkeypox, West Nile virus, and Hepatitis A -- to address the following questions: (1) How did the public health system in the United States respond to each of these disease outbreaks? What were the roles of federal, state, and local health departments, health care providers, community organizations, and other groups, and how did they interact? (2) In what ways did recent federal investment contribute to public health preparedness? (3) What lessons does the public health response to these outbreaks have for future preparedness, particularly to address the threat of bioterrorism? What improvements are needed to public health infrastructure in the United States and in functional capabilities to address a public health emergency? (4) Was the Centers for Disease Control (CDC) guidance helpful in building capacity for health departments to respond to the outbreaks studied? Are there areas in which guidance is still needed?

New medical technologies pharmaceuticals, medical devices, and procedures often allow great improvements in the outcomes of medical care, but they are also widely believed to be a major cause of increasing costs. Selective adoption of new technologies, the taking on of only those technologies for which the medical benefits exceed the costs to society of developing and using them, is a crucial element in the quest to control health care costs while preserving or enhancing the quality of care. This report focuses on adoption of innovative medical technologies by managed care organizations (MCOs). The project had two primary objectives: (1) to understand current processes MCOs use for making coverage, medical-necessity, and payment decisions involving emerging medical technologies, and how device developers and manufacturers prepare for and participate in these processes; and (2) to identify ways that private, voluntary action by the managed-care and medical-device industries individually or jointly might improve for the benefit of society the processes by which new medical technologies are developed, evaluated, and adopted or rejected for coverage.

New medical technologies-pharmaceuticals, medical devices, and procedures-often allow major improvements in the outcomes of medical care, but they are also widely believed to be a leading cause of increasing costs. Selective adoption of new technologies, the taking on of only those technologies for which the medical benefits exceed the costs to society of developing and using them, is a crucial element in the quest to control health care costs while preserving or enhancing the quality of care. This report focuses on adoption of innovative medical technologies by managed care organizations (MCOs). The project had two primary objectives: (1) to understand current processes of MCOs for making coverage, medical-necessity, and payment decisions involving emerging medical technologies, and how device developers and manufacturers prepare for and participate in these processes; and (2) to identify ways that private, voluntary action by the managed-care and device industries individually or jointly might improve-for the benefit of society-the processes by which new medical technologies are developed, evaluated, and adopted or rejected for coverage.