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The mapping of the human genome and related advances in genetics are stimulating the development of public policies on genetics. Certain notions that currently prevail in public policy development overall--including the importance of protecting privacy of information, an interest in cost-effectiveness, and the power of the anecdote--will help determine the future of public policy on genetics. Information areas affected include discrimination by insurers and employers, confidentiality, genetic databanks, genetic testing in law enforcement, and court-ordered genetic testing in civil cases. Service issues address clinical standards, insurance benefits, allocation of resources, and screening of populations at risk. Supply issues encompass funding of research and clinical positions. Likely government actions include, among others: (1) Requiring individual consent for the disclosure of personal information, except when such consent would impose inordinate costs; (2) licensing genetic databases; (3) allowing courts to use personal information in cases where a refusal to use such information would offend the public; (4) mandating health insurers to pay for cost-effective genetic services; (5) funding pharmaceutical research to develop tailored products to prevent or treat diseases; and (6) funding training programs.

There's no formula for making the right clinical decision in the face of competing factors of personal values, cost-quality trade-offs, insufficient information, and social environments that lie beyond the clinician's reach.

The Medical Society of New Jersey has developed a detailed position statement on the regulation of health maintenance organizations (HMO). This statement has been presented to an advisory committee of the New Jersey State Department of Health, which is preparing new HMO regulations.

Highlighting state developments that generated diverse reforms, the author summarizes the recent course of health system reform in New Jersey and identifies key issues facing all New Jersey physicians during the current Whitman administration.

New Jersey's Nursing Incentive Reimbursement Award program provides competitive grants to hospitals to develop innovative nursing service programs that improve patient care. The program's overarching concept is that nursing ideas and action should percolate up to the State Health Department level from the level of direct care providers.