In This Issue T he Milbank Memorial Fund is celebrating its one-hundredth anniversary this year. A centennial is a time for reflection. We look back at what the Fund has accomplished over the last century through its work with individuals and organizations, work that has addressed a wide range of issues in health and social policy. The Milbank Quarterly has been an essential part of this work since its inception in 1923. For this special issue of the Quarterly, we have selected articles from past issues that provide insight into the role of both the Fund and its journal in addressing major policy questions for health services and population health for more than eighty years.Selecting the articles for this issue from the Quarterly's eighty-three volumes was difficult. We agreed that the selected articles should be interesting to read in 2005. Moreover, they should discuss major issues in health policy as well as aspects of the Fund's work during the past eight decades. We looked for articles that dealt with issues that were important in the past and are still significant today, such as health care coverage for the uninsured, the cost and organization of health care, and the growing prevalence of chronic illness. The articles we chose also provide examples of how scholarship in the disciplines that study health services and population health has changed over time.

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This paper assesses the impact of mechanisms for financing intensive home health care services in the United States on their utilization. As lengths of stay have decreased in response to prospective payment methods for hospitals, demand has increased for intensive and complex services provided to patients in the home. Third-party payers, however, are willing to satisfy only some of this potential demand that their reimbursement policies have generated. It is the policies of payers rather than the safety and effectiveness of devices and procedures that are the major constraints on the expansion of intensive home health care. We describe the effects of these policies on who receives intensive home health care services, who provides them, what services are provided, how their quality is monitored, and what they cost.

Since 1991, leaders in health policy from the legislative and executive branches of state government have come together, with financial support and staff collaboration from the Milbank Memorial Fund, to share their experiences and to work on practical solutions to pressing health care problems. What began with a handful of states at the forefront of health reform is now the Reforming States Group (RSG), a bipartisan, voluntary association that includes leaders from over 40 states. This article describes the origins, history, and future prospects of the RSG.

In October 1984, a diverse group that included physicians and other health professionals, attorneys, members of the press, ethicists, and social scientists met for two and a half days at the State University of New York at Stony Brook to discuss the medical, ethical, and social issues raised by the treatment of handicapped newborns. The most important recommendation of the conferees was that every institution that treats handicapped newborns should have an explicit policy on how difficult treatment decisions will be made and how their institutional consequences will be managed. The need for explicit policy is a result both of changes in the external regulatory environment and of the inherent difficulty of decisions about treating handicapped newborns. Institutional policy should address both internal decision-making processes and how information about controversial cases will be shared with various publics. What follows is a summary of the conferees' views about what physicians and hospital staff should consider in establishing policies for their institutions.