title: Top-down and bottom-up approaches to health care quality: the impacts of regulation and report cards.
abstract: The high cost of the US health care system does not buy uniformly high quality of care. Concern about low quality has prompted two major types of public policy responses: regulation, a top-down approach, and report cards, a bottom-up approach. Each can result in either functional provider responses, which increase quality, or dysfunctional responses, which may lower quality. What do we know about the impacts of these two policy approaches to quality? To answer this question, we review the extant literature on regulation and report cards. We find evidence of both functional and dysfunctional effects. In addition, we identify the areas in which additional research would most likely be valuable.
authors.affiliation: School of Medicine and Health Policy Research Institute (HPRI), University of California, Irvine, California 92697-5800; email: dmukamel@uci.edu.
authors.forename: Dana B
authors.initials: DB
authors.lastname: Mukamel
authors.forename: Simon F
authors.initials: SF
authors.lastname: Haeder
authors.forename: David L
authors.initials: DL
authors.lastname: Weimer
mesh_terms: D019985:Benchmarking / Q000379:methods*; D033161:Government Regulation; D058016:Health Facility Administration / Q000331:legislation & jurisprudence*; D006707:Homes for the Aged / Q000458:organization & administration; D006801:Humans; D008484:Medicaid / Q000458:organization & administration; D009735:Nursing Homes / Q000458:organization & administration; D057240:Patient Preference; D010561:Personnel Staffing and Scheduling; D057766:Policy; D058996:Quality Improvement; D019984:Quality Indicators, Health Care; D011787:Quality of Health Care / Q000331:legislation & jurisprudence / Q000458:organization & administration*; D014481:United States