Definition of Serious and Complex Medical Conditions -- Copyright -- Acknowledgments -- Contents -- Executive Summary -- CONCLUSIONS -- 1 Introduction -- CHARGE TO THE INSTITUTE OF MEDICINE -- SCOPE AND ORGANIZATION OF THIS REPORT -- DEFINITIONS OF SERIOUS AND COMPLEX MEDICAL CONDITIONS: ALTERNATIVES AND IMPLICATIONS -- Background -- Conceptual Overview-Serious and Complex Conditions -- Potential Operational Definitions and Criteria -- Disease Code Definitions -- ICD-9 Codes Alone -- 2 Challenges in Health Care Delivery for Patients with Serious and Complex Medical Conditions -- QUALITY OF HEALTH CARE -- Patient Characteristics -- Provider Characteristics -- Patient Volume -- Health Care Delivery System -- ACCESS TO CARE -- HEALTH CARE COST CONTAINMENT -- Medicare and Medicaid -- Utilization Review and Management -- Care Management -- Screening and Risk Assessment -- Alternative Strategies for Cost Containment -- 3 Conclusions and Recommendations -- INTRODUCTION -- CONCLUSIONS -- References -- Appendix A Workshop to Define Serious or Complex Medical Conditions -- CLINICAL IMPLICATIONS OF DEFINING SERIOUS OR COMPLEX MEDICAL CONDITIONS -- Disabled Populations -- Complexities of Patients with Cancer -- Serious and Complex Chronic Illness at the End of Life -- Example of a Population-Based Screening Intervention for Care Delivery Integration -- HEALTH CARE POLICY AND INSURANCE IMPLICATIONS OF DEFINING SERIOUS OR COMPLEX MEDICAL CONDITIONS -- Managed Care and Approaches to Regulation -- Implementation Strategies for the Medicare+Choice Regulations Concerning Serious or Complex Medical Care -- Serious or Complex Medical Conditions: Insurance Issues -- Appendix B Speakers Biographies -- Appendix C Workshop Agenda -- Appendix D Workshop Participants -- Appendix E Committee Biographies.