Competition and Quality

Published in: Health Affairs, v. 7, no. 3, Summer 1988, p. 150-161

by Robert H. Brook, Jacqueline Kosecoff

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The world changes, and even the health care system is affected. Many consider the future of the fee-for-service system in the United States, the free-market center of the world, to be gloomy. Its antithesis, fixed payment per capita care, is here to stay. Increasingly, physicians work as employees, patients have become consumers, and business school graduates are assuming control. As independent-practice-model health maintenance organizations (HMOs) grow rapidly, staff- and group-model HMOs are scared: will they go the way of the fee-for-service system? Competition, for the time being, seems to be king. This article is written by a physician and a social scientist who, collectively, have devoted thirty years to researching quality of care. We have read hundreds of papers about quality of care. Most contain little or no data. Most proclaim the need for more or better data. Most make conclusions even when there are no data. Should they be read? Should their advice be heeded? These are not easy questions, particularly when the search for answers has become so intense.

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