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The market relies on the use of quality data by health care purchasers and consumers in choosing plans and providers. The underlying assumption is that quality is a market force on a par or nearly so—with cost.
The professional community relies on the actions of private-sector accreditation groups, trade associations and health plans, hospitals, and other providers to ensure quality. The profession assumes leadership for policing itself and demonstrating quality to outside parties.
Although these categories are convenient for describing the forces at work, they are not entirely independent, and in fact, the number of public and private collaborative efforts is increasing. For instance, the President's Advisory Commission on Consumer Protection and Quality in the Health Care Industry (1998) recommended that two complementary bodies be formed on health care quality one lodged in the public sector to promote interagency coordination among federal agencies (Quality Interagency Coordination Health Care Task Force), and the other in the private sector to improve health care quality measurement and reporting (National Forum for Health Care Quality Measurement and Reporting). The goals of the Quality Forum are to (http://www.uhfnyc.org/intro/qfpc.htm):
ensure system-wide capacity to evaluate and report on the quality of care,
promote and inform consumer choice and further consumer understanding and use of quality measures,
enable providers to use data to improve performance,
allow meaningful quality comparisons of health care providers and plans,
promote competition on the quality of health care services,
use broad representation to marshal market forces for quality, and
reduce the burdens on providers and health plans by enabling them to collect consistent data that avoids duplication.
This chapter first considers the individual consumer's point of view in describing the strengths and weaknesses of the tools and information available to help understand accountability in cancer care and the quality of such care. Next, the forces that affect accountability are described, using the three categories listed above. Finally, some of the specific activities that are in place to try to measure and improve the quality of health care (and cancer care, specifically) are described.
Quality Assurance: an Individual Consumer Perspective
Most people are healthy when they first select a health plan or source of care and so do not focus specifically on the quality of cancer care. Then too, even if consumers wanted to comparison shop for a health plan on the basis of quality, many have no real choice of health plan. Most individuals under age 65 are insured through their employer, and less than half of employees (41 percent) who are offered insurance at work can choose among two or more plans (Long and Marquis, 1998). Furthermore, most new cases of cancer occur among those age 65 and older