Even if reimbursement policies were to fully support the provision of all the psychosocial services described above, individuals being treated for cancer might still be unlikely to receive the psychosocial health services they need to manage their illness effectively. The many studies of health care quality conducted in the United States in recent years that have found widespread deficiencies in care, including underprovision of needed services (Fisher et al., 2003; McGlynn et al., 2003; Hussey et al., 2004; AHRQ, 2006), clearly show that the availability of reimbursement by itself does not ensure the provision of needed health care. Accordingly, many professional associations, payers, regulators, accrediting bodies, consumer groups, and other organizations have undertaken initiatives to report publicly on the performance of health care providers in delivering quality health care, use payments to create incentives for higher-quality care, and/or directly implement quality improvement programs at the provider level. Two mechanisms are common to all three of these pathways to better health care: (1) measuring the attainment of certain aims of quality health care by health care providers and the health care system overall (performance measurement), and (2) using the results of performance measurement to leverage changes in the way health care is delivered (IOM, 2006b).
Use of these two mechanisms to improve the delivery of psychosocial services to cancer patients and their families is hindered in part by the same overall problem that afflicts all of U.S. health care: the nation’s lack of “a coherent, goal oriented, consistent, and efficient system for assessing and reporting on the performance of the health care system” (IOM, 2006b:2). Certain health care organizations, group purchasers, communities, and others have nonetheless used performance measurement to achieve improvements in the segment of the health care system they can influence. However, there are two additional obstacles to similar efforts to improve the psychosocial health care provided to patients with cancer: less well-developed measures of the delivery of psychosocial health services, and a less well-developed network of organizations and partnerships to ensure the application of such measures.
Measurement of Psychosocial Health Care
As experts have noted, some areas of health care have better-developed performance measures than others (IOM, 2006b). Mental health care, for example, historically has been less well addressed in national performance measurement and quality improvement initiatives (IOM, 2006a), although this gap is narrowing. Performance measures for the delivery of a more