Examines the interrelationship and tradeoff between quality assurance and cost control in ambulatory care. The author highlights the policy questions that must be addressed in deciding how to improve health and what levels of resource commitment are needed. Issues discussed: (1) the marginal benefit to health produced by additional investments in ambulatory care; (2) changes in the structural characteristics of the medical care system to improve quality; (3) the need for improved physician performance; and (4) the cost of quality assurance activities and how it can be kept in bounds by physicians who know the major problems in the delivery of care in the environments in which they practice. Physicians are urged to be prepared to participate in these larger policy issues so that the direction taken by quality assurance and cost control activities will benefit from their expertise.
This report is part of the RAND Corporation Paper series. The paper was a product of the RAND Corporation from 1948 to 2003 that captured speeches, memorials, and derivative research, usually prepared on authors' own time and meant to be the scholarly or scientific contribution of individual authors to their professional fields. Papers were less formal than reports and did not require rigorous peer review.
Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/principles.
The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.