Assuring the Quality of Medical Care: The Impact of Outcome Measurement and Practice Standards

Abstract

For the better part of the last decade, the major goal of health care policy has been to reduce health care costs. This has raised fears that the quality of care may suffer, as providers cut corners in response to cost containment pressures from the government and other third-party payers.These concerns over quality in turn have increased interest in the complex systems that monitor and regulate health care quality. Three main questions have been raised about the ability of the quality assurance systems to assure the quality of care. First, they may not be sufficiently effective, especially given the threat to quality posed by efforts to contain costs. For example, quality assurance has been criticized for focusing on a small number of aberrant physicians and hospitals—a so-called “bad apples” approach—rather than on improving the overall quality of care and for failing to identify more than a handful of the poor quality providers believed to exist.