Even in the absence of financial barriers, individuals may not receive quality care because of where they live, language or cultural barriers, and late adoption on the part of health care providers of effective interventions.

Chapter 4 defines quality cancer care, describes the ways in which it can be measured, and documents important gaps in the quality of care for individuals with breast or prostate cancer, two cancers for which there have been quality assessments.

Chapter 5 summarizes evidence on the ways in which three aspects of the health care delivery system can affect the quality of cancer care: (1) the volume of services provided either by institutions or by individual providers; (2) specialization in cancer care either by institutions or by individual providers; and (3) managed care.

Chapter 6 reviews and critiques the means of monitoring quality and accountability that are in place.

Chapter 7 surveys ongoing health services research that addresses cancer-related quality issues sponsored by selected federal agencies and private organizations.

Chapter 8 summarizes the key findings and presents the Board's recommendations for action by Congress, health care purchasers, health plans, health care providers, individual consumers, and health services researchers.


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