Forward

This report describes for policymakers the promise and limits of the application to health services of current research-based knowledge about genetics. The Milbank Memorial Fund commissioned this report from a noted scientist on behalf of an informal group of persons who make policy for purchasing health care in the United Kingdom and the United States. The members of this group are identified above. The Fund is an endowed foundation, based in New York City. It collaborates with policymakers in the public and private sectors to analyze, develop, implement, and communicate about health policy.

The group of purchasers met in London in 1997 and in New York the next year. The purpose of these meetings, as a British purchaser wrote, was to

consider the developments that have taken place…in relation to purchasing, as the process has become more sophisticated and specifically to address the issue of the information that purchasers need to purchase effective and cost-effective health care…Discussing the developments and limitations of the situation in [each] country in the presence of individuals from a different system, but with many areas of shared concern, is…likely to be mutually beneficial.

The organizers of these meetings hypothesized that people who did similar work each day would find common interests despite the enormous differences in the organization and financing of health services in the United Kingdom and the United States. Moreover, focusing on common interests might reduce the tedious hours of elementary descriptions of national health care policies and systems that absorb considerable time at many international meetings.

The hypothesis proved correct. The UK purchasers––each of whom worked within the National Health Service––and the US purchasers––who served in the executive and legislative branches of government, private industry, and a public corporation––immediately found common ground. They described their systems and policies in the context of discussing problems in purchasing health services for populations.

The members of the group have completed three projects. This report describes the implications for policy of research on genetics. A report now in press assesses the extent to which purchasers in both countries use the results of research on the effectiveness of health care interventions. The third project convened experts in assessing health care technology from the two countries to explore practical possibilities for collaboration in the dissemination of information.

Many people deserve credit for this report. Alan Burns and Helen Darling led the group in formulating questions about genetics to which policymakers wanted answers. Ron Kerr recommended that we commission Steve Jones to write the report and helped to recruit him. John James and Barbara Stocking participated in describing the overall purpose of the group and recruiting its members from the United Kingdom. These people are identified by title above. Barbara Stocking, Regional Director, National Health Service Executive, Southeast Regional Office, could not participate in the ongoing work of the group. Professor Jones’s achievements are described in more detail in a biographical note that follows the report.

Members of the group reviewed several drafts of this report. In addition, three scientists reviewed the accuracy and clarity of the scientific information in the report: Celia I. Kaye, Professor and Chairman, Department of Pediatrics, The University of Texas Health Science Center at San Antonio; Arthur C. Upton, President, The Ramazzini Institute, and Clinical Professor, Robert Wood Johnson Medical Center, Newark, N.J.; and Ron Zimmern, Public Health Genetics Unit, Strangeways Research Laboratory, Cambridge, U.K.

Daniel M. Fox
President

Samuel L. Milbank
Chairman