Mark A.Schuster, M.D., Ph.D.;1 Elizabeth A.McGlynn, Ph.D.;2 Cung B.Pham, B.A.;3 Myles D.Spar, M.D.;4 and Robert H. Brook, M.D., Sc.D.5
Submitted January 1999
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 (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. The nation has 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.
In 1997, the National Coalition on Health Care (NCHC) commissioned us to review the academic literature for articles that provide evidence of the quality of care in the United States (Schuster et al., 1998). The Institute of Medicine’s