The challenge of a health care system in crisis
Over the course of the last three decades, medical science has pushed the boundaries of our imaginations by creating new, mysterious and astonishingly complex ways to treat the human body. From front porches to the highest levels of our government, Americans are engaged in a constant, noisy, and largely unproductive debate about topics ranging from the inception of life to questions about how we want to die. Infused in much of this discussion is the looming shadow of how much the United States health care system costs. There has been much less discussion of how well the system does what it is intended to do - keep Americans healthy, and improve the quality of their lives. Here in the US, our health care providers are best at doing organ transplants and invasive cardiac surgery. Our health care system is seriously deficient in providing preventive care, monitoring the status of the chronically ill, and delivering appropriate care at the end of life, things that cost much less to do and have greater benefits than the “heroic” measures that have earned – perhaps unjustifiably – the reputation of constituting the "best healthcare system in the world."

Asking the questions
As with most areas of scientific exploration, academicians lead the way by illuminating the questions that beg answers. Typically, researchers in the health care fields frame the debate within specific parameters: what does a day in the hospital cost? How can patients be encouraged to demand less care? How can financial incentives be used to encourage doctors to practice in "underserved" areas?

Achieving a diagnosis
To study the health care system requires science as rigorous as that used in any other field of medical research. However, like a patient with a litany of symptoms, diagnosing what ails our health care system can only be achieved through new ways of thinking - born of a ground-breaking spectrum of research. Without an accurate diagnosis, appropriate treatment is a matter of chance.

Looking deeper
The Dartmouth Institute for Health Policy and Clinical Practice (formerly the Center for the Evaluative Clinical Sciences), has single-handedly initiated a critical dialogue targeted at more fundamental and strategically important questions: What are the "right" medical interventions? How well do they actually work? How often does the "right" thing - from the point of view of biomedical science, the patient's preferences, and societal interests - actually get done?

The next fifteen years
Within the national arena of medical science studies, The Dartmouth Institute (TDI) has been a beacon of light over the course of the past fifteen years, illuminating the disconnect between those who are in dire need of affordable and effective medical treatment and those who provide it. The magnitude of the impact of this work is already recognized. However, TDI has only completed the earliest stages of fulfilling its mission. To fully develop the breadth of purpose and the integrity of the research conducted under its auspices, TDI will reorganize its work into four areas of activity, each of which will focus on a major area where change in the health care system must occur.

Over the next fifteen years, TDI will continue its ground-breaking work in health policy, informed patient choice, quality improvement, and education, while further establishing new and innovative projects within the multi-disciplinary framework that characterizes the efforts of this unique and visionary group.

This remarkable partnership of The Dartmouth Institute, Dartmouth Medical School, and Dartmouth-Hitchcock Medical Center has already established a national model and working laboratory for innovation and positive change in our health care system. At a time when there seem to be too many questions and too few answers about to how to repair a broken system, the TDI offers a science-based, methodological approach to analyzing and proposing solutions that can and will work.

For more information visit The Dartmouth Institute web site.