The quality dilemma.
In the language and logic of the free market, providers of health care will have to demonstrate the quality of their work. However, in this setting quality is only interpreted in quantitative ways and consequently does not necessarily do justice to good physicians. Moreover, both outcome measures and process measures have serious drawbacks. An emphasis on outcome measures will disadvantage physicians working in deprived areas and doctors managing more complicated cases. Although process measures give the most direct information on the physician's performance, their evidence base is not always as straightforward as commonly supposed. Finally, measurement of quality indicators is complicated and time consuming. Physicians should be aware of the drawbacks of quality measurement and of the poor effects of quality improvement strategies on patient outcomes.
Lucassen
Peter
P
Radboud University Nijmegen, Department of General Practice, PO Box 9101, afd 117, 6500 HB Nijmegen, The Netherlands. p.lucassen1@chello.nl
D003695:Delivery of Health Care / Q000191:economics* / Q000458:organization & administration; D006302:Health Services Research / Q000379:methods; D006801:Humans; D010043:Outcome and Process Assessment, Health Care / Q000379:methods* / Q000458:organization & administration; D017060:Patient Satisfaction; D010820:Physicians; D011785:Quality Assurance, Health Care / Q000379:methods* / Q000458:organization & administration; D019984:Quality Indicators, Health Care