The purpose of this article is to describe what is happening in the provision of health care throughout the Western world and to make a case, although briefly, for using both economic and clinical incentives to change the health system so that more health is produced from it. In this formulation, the quality of care provided, as opposed to the way services are organized or reimbursed, becomes of central concern.
Despite evidence from health services research studies that the level of the quality of health care is a major crisis throughout the Western world, this fact is rarely acknowledged by most elements of society. An exception to this statement is the American concern, based mostly on individual case reports, that managed care will adversely affect quality of care. Yet even this concern is focused on the potential evils of managed care and not on major problems in producing quality care