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The Missing Ingredient in Health Reform Quality of Care

Mark R. Chassin, MD, MPP, MPH
JAMA. 1993;270(3):377-378. doi:10.1001/jama.1993.03510030101043.
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The current public debate over health reform has focused on issues of access and cost, on what benefits will be in or out, and on how competition will be "managed." Very little attention has been paid to how quality of care will be assured and improved, to how the health of the public will be protected in the headlong rush to control costs.

Assured quality must be a principal goal of health reform, fully equal to the goals of universal access and affordable cost. We must measure the success of any health reform effort by how well it accomplishes all three goals. In fact, I would argue that the goal of assured quality holds the key to our ability to control costs safely, without jeopardizing health.

See also p 331.

It is by now a truism that costs will be controlled. Our only choice is how—by medically irrational means (such


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