Health care is one of the most important industries in any country, ranging from 3 to 18 percent of a nation’s gross national product (GNP). It is considered a service industry rather than a production industry because it involves providing human effort to preserve and improve people’s lives. It also provides employment opportunities and contributes to the social, religious, and economic fabric of a community.
It is a complex and controversial subject because it involves many different interests. Individuals want health care that will maximize their potential to pursue life goals and to meet their personal needs; societies seek to ensure equitable access to essential health services. These wants are placed in the context of rapidly increasing costs and uncertainty about the effectiveness of component health services for specific groups of patients.
Moreover, the delivery of health care is highly personal and intimate. The interaction between patients and health care providers often reflects the cultural, ethical, and religious values of the patient and society. As a result, it is difficult to compel individuals to buy and use health care. It is also difficult to evaluate the quality of health care in a way that can be compared with other goods and services.
A common definition of health care includes medical, nursing, and hospitalization services as well as physician-directed home care, ambulatory surgery, diagnostic testing, and other allied health care activities. This definition of health care is often used as the basis for comparing the quality of health care in different countries. However, there are differences in the way in which this definition is interpreted and implemented.
In an ideal market, competition among health care providers in response to consumer demand would work to improve quality by eliminating bad performers and rewarding good ones (e.g., HCFA’s release of provider-specific mortality data). However, this tenet is not fully viable in health care because information on providers is never perfect or complete; it cannot be transmitted quickly and at low cost; and the products being purchased–health care services–are highly heterogeneous because they apply to unique individuals.
Furthermore, the strong trends toward integrating financing and delivery of services and the growth of for-profit enterprise in health care have serious implications for quality. Some professionals believe that these forces lead to conflicts within, or erosion of, the traditional physician-patient relationship and create barriers to providing continuity of care.
Another area of contention is the concept of professionalism. The drive for professionalism is viewed by some to be at odds with other influences that affect the delivery of health care, including regulatory agencies, marketplace forces, and the adversarial atmosphere entailed in malpractice litigation.
The resulting countervailing forces or conflicts are the source of much of the dissatisfaction with the quality of health care. To bridge these gaps, the Committee on Quality Assurance and Utilization Review recommends that a unifying factor be developed that could promote the strategy of using information to improve quality by linking utilization management and quality assurance programs, ensuring operational links between the two efforts, and acknowledging that health care is not simply bought and sold but also produced by dedicated individuals (CQAUR, 1989). In addition, the definition of quality should exclude resource considerations.