Evaluating health plan quality 1: a conceptual model.
OBJECTIVE
To develop a theoretical foundation for measuring health plan quality from a physician's perspective.


METHODS
Literature review and theory development.


METHODS
We defined health plan quality as the degree to which health plan management practices increase the likelihood of high-quality care for individuals and populations and addressed the ways in which health plan quality is similar to, and different from, other commonly used quality measures. Based on an assessment of the literature, we proposed a conceptual model that organizes health plan care management practices into a coherent structure for measuring health plan quality.


RESULTS
A conceptual model of health plan operation that organizes managerial practices into a structure for measuring health plan quality from a physician's perspective was developed.


CONCLUSIONS
Health plan quality is distinct from quality of care, and physicians can provide unique, timely, and reliable information about aspects of health plan quality.
Wholey
Douglas R
DR
Division of Health Services Research and Policy, University of Minnesota, Minneapolis, Minn 55455, USA. whole001@umn.edu
Christianson
Jon B
JB
Finch
Michael
M
Knutson
David
D
Rockwood
Todd
T
Warrick
Louise
L
D001291:Attitude of Health Personnel; D006801:Humans; D008329:Managed Care Programs / Q000458:organization & administration / Q000592:standards*; D008330:Management Audit / Q000379:methods; D008962:Models, Theoretical; D010820:Physicians / Q000523:psychology*; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000458:organization & administration; D014481:United States