How Good Is the Quality of Health Care in the United States?

Published in: The Milbank Quarterly, v. 83, no. 4, Dec. 2005, p. 843-895

Posted on RAND.org on December 31, 2004

by Mark A. Schuster, Elizabeth A. McGlynn, Robert H. Brook

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Quality of health care is on the national agenda. In September 1996, President Clinton established the Advisory Commission on Consumer Protection and Quality in the Health Care Industry, which has released its final report on how to define, measure, and promote quality of health care (Presidentb2ss Advisory Commission on Consumer Protection and Quality in the Health Care Industry 1998). Much of the interest in quality of care has developed in response to the dramatic transformation of the health care system in recent years. New organizational structures and reimbursement strategies have created incentives that may affect quality of care. Although some of the systems are likely to improve quality, concerns about potentially negative consequences have prompted a movement to assure that quality will not be sacrificed to control costs. The concern about quality arises more from fear and anecdote than from facts; there is little systematic evidence about quality of care in the United States. There is no mandatory national system and few local systems to track the quality of care delivered to the American people. More information is available on the quality of airlines, restaurants, cars, and VCRs than on the quality of health care. The authors conducted a review of the academic literature for articles on quality of care in the United States, and we summarize our findings in this article. In the absence of a national quality tracking system, such a summary is the best way to provide an overview of the quality of care delivered in the United States. The authors provide examples to illustrate quality in diverse settings, for diverse conditions, and for diverse demographic groups, and to offer insight into the quality that exists nationwide.

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