Evaluating Quality of Health Care for the Disadvantaged

A Literature Review

by Robert H. Brook, Kathleen N. Williams

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The current literature on the assessment of quality of health care is reviewed in terms of health care for the American public in general and for the disadvantaged populations in particular. Four principal conclusions are drawn: (1) differentials in health status between the disadvantaged and the nondisadvantaged persist; (2) differentials in the overall amount of health care received are less dramatic than in the past, but standardization by need demonstrates discrepancies in health services provided to the disadvantaged compared with the nondisadvantaged; (3) quality of health care in general has demonstrable shortcomings, but the technical quality of care for the disadvantaged is not strikingly poorer than care for the nondisadvantaged; and (4) efforts to improve the quality of care for the disadvantaged (through traditional or innovating means) have not had the hoped-for impact. Four new avenues for policy-related research and evaluation are discussed; these involve greater patient responsibility, increased consumer knowledge, financial accountability, and quality assurance activities.

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