Publication of comparative performance data does not automatically produce
improved clinical performance. The effectiveness of the marketplace to promote
improved care, if only accurate quality measurement can be made available,
is an article of faith among some students of health policy because market
forces are an attractive alternative to increased government regulation. The
reality is more complex.
For years, there was serious debate as to whether quality of care was
measurable at all. Today, there is substantial consensus that quality can
be measured in some important areas of health care. For the last decade, purchasers
and business coalitions have pressed for collection and publication of data
on outcomes and critical processes of care so the marketplace can promote
quality. The health care community has been buffeted by demands for more data
on practitioner, provider institution, and health plan performance and beset
by the burdens of data collection and the difficulties of producing accurate,
risk-adjusted information. While there is some disagreement about what aspects
of care are considered quality, there is little disagreement
that the effectiveness of care in bringing about desired outcomes is an important
aspect of quality. In particular, survival rates for elective surgery, if
properly adjusted for patient risk, have high face validity as a measure of
hospital and surgeon performance.
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