The remainder of this summary first describes the methods of the study and summarizes the committee’s findings and conclusions. It then gives the committee’s 10 major recommendations and describes the main operational features of a Medicare Program to Assure Quality (MPAQ), as the committee denotes the new program it recommends be established. Finally, it outlines a three-phase, 10-year implementation strategy, during which time many details of the program will evolve.


The nation is generally perceived to have a solid, admirable base of good quality health care, and the elderly are usually satisfied with the quality of care they themselves receive. Contrasting with this positive perception of the overall quality of care in the nation is a large literature that documents areas of deficiencies in all parts of the health sector. Some of these relate to the overuse of unnecessary and inappropriate services, some to underuse of needed services, and some to poor technical skills, interpersonal care, or judgment in the delivery of appropriate services.

Significant problems exist in quality of care and in the nation’s present approaches to quality assurance. These problems are sufficient to justify a major redirection for quality assurance in this country and, in particular, a more comprehensive strategy for quality assurance in Medicare.

Our major findings and conclusions include the following:

  • A quality assurance program should be guided by a clear definition of quality of care.

  • No single approach or conceptual framework to quality assurance is likely to suit all purposes.

  • Regarding the elderly,

    • their population continues to grow, both in absolute numbers and as a proportion of the entire population,

    • the average number of years lived after age 65 continues to increase, and

    • an increasing number of the elderly live with chronic illness and disabling conditions.

  • Regarding Medicare and the elderly,

    • health care costs continue to rise,

    • pressures for cost containment increase, and

    • use of sites of care other than inpatient (i.e., outpatient, long-termcare, and home) continues to expand.

  • Near universal coverage of the elderly population by the Medicare program gives them better access to health care than any other age group; nevertheless, gaps in coverage and financial barriers do exist and adversely affect quality.

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