The Quality of Health Care

Whether personally or collectively, people want health care that maximizes their health potential and meets their health goals. They also want to ensure equitable access to essential health services. This desire in combination with rapidly increasing health care costs and unexplained variations in the use of services by different providers for seemingly similar patients create a context in which many are concerned about quality of healthcare.

Health care includes a broad set of services that may include acute, chronic, preventive and restorative. The nature of these services, as well as the delivery settings in which they are provided and by whom, can impact on their quality. Quality can be measured in terms of effectiveness, efficiency and fairness. Some measures of quality focus on the technical, scientific and medical aspects of health care, while others emphasize patient satisfaction and outcomes such as improvement in self-rated health.

Many of the issues that arise around healthcare quality revolve around resource allocation. These can be macroallocation issues involving the size of the healthcare system or government and at the level of healthcare professionals allocating their own time to specific patients.

Healthcare can be delivered in a wide range of settings and through a variety of providers including hospitals, clinics, physicians offices, home health agencies and long-term care facilities. Individuals can be paid for their health care through private or public insurance, through employer-provided benefits or directly by the consumer. The health care system can be organized into a series of regional or national networks of healthcare providers, referred to as “provider networks,” with each network defining the range of healthcare professionals who are members and the geographic area in which they provide care. Some health plans require their members to stay within their provider network, while others allow them to seek care out-of-network but at a higher cost sharing percentage for the insured.

Those with libertarian sympathies believe that the role of government should be to allow the free market to operate in healthcare, allowing individuals and private companies to form healthcare practices and companies and for-profit or not-for-profit insurance providers. This approach is based on the view that healthcare should be privately provided and funded, with government intervention limited to those functions that can’t be accomplished through the market mechanism alone such as maintaining order in society.

Some think that healthcare should be evaluated in financial terms such as the amount of money spent and the number of lives saved or improved. This approach can be applied to decisions about healthcare alternatives as well as broader social choices such as alternative energy technologies or transportation infrastructure. This approach is sometimes referred to as cost-benefit analysis. However, other concerns such as the role of fairness and equity in healthcare decision-making can undermine this type of approach to evaluating alternatives. For example, a person’s ability to access healthcare may be affected by factors such as poverty (which often relates to other personal and lifestyle characteristics) rather than by their choice of healthcare provider.

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