ous government health care programs to ensure that their quality enhancement processes adhere to the following guiding principles:

  1. Government health care programs should establish consistent quality expectations and requirements and apply them fairly and equitably to all financing and delivery options within a program.

  2. Government health care programs should promote and encourage providers to strive for excellence by providing financial and other rewards and public recognition to providers who achieve superior levels of quality.

  3. Government health care programs should actively collaborate with each other and private-sector quality enhancement organizations with regard to all aspects of quality enhancement—including use of standardized measures and sharing of data—where doing so will likely result in greater gains in quality or reduced provider burden.

  4. Government health care programs should encourage and enable active consumer participation in efforts to enhance quality through such means as the following:

    1. Raising consumer awareness of the magnitude of quality and safety shortcomings and the means of addressing these problems

    2. Seeking consumer input into the design and evaluation of quality enhancement processes

    3. Including patient assessments of quality and service in the portfolio of performance measures

    4. Providing patients with health information necessary to evaluate treatment options and participate in care management

    5. Providing consumers with comparative performance data on providers and health plans

  1. Government health care programs, in collaboration with the Agency for Healthcare Research and Quality (AHRQ), should pursue a rich agenda of applied research and demonstrations focusing on tools, techniques, and approaches to quality enhancement.


In providing leadership to effect the needed changes in health care, the federal government should take full advantage of its unique position as a regulator; purchaser; health care provider; and sponsor of research, education, and training. As regulator, the federal government sets the standards for minimally acceptable performance. As the largest purchaser of health care services, the federal government institutes payment policies that determine the financial rewards or penalties that either spur or stifle innovations aimed at improving safety and quality. As a direct provider of health care services to veterans, military personnel and their families, and

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