Abstract The current healthcare quality improvement infrastructure is a product of a century long experience of cumulative efforts. It began with an acknowledgement of the role of quality in healthcare, and gradually evolved to encompass the prioritization of quality improvement and the development of systems to monitor, quantify, and incentivize quality improvement in healthcare. We review the origins and the evolution of the US healthcare quality movement, identify existing initiatives specific to musculoskeletal care, outline significant challenges and opportunities, and propose recommendations for the future.
This article is published in collaboration with the Bill and Melinda Gates Foundation. Scientific advancement in healthcare has allowed human beings to double their life spans and effectively address lethal diseases such as malaria, cholera and the plague that have in the past wiped out entire civilizations.
While there is no disagreement among policymakers on the importance of healthcare, a key area of debate relates to the relative role of the government and the market in the provision and financing of healthcare. The position of the market purist is that since people can buy all the services that they want, the invisible hand of the market will produce the best possible outcomes.
If some people do not have enough money, the purist would argue that the government needs only to tax the rich and transfer cash to the poor so that they too are able to freely participate in the market for healthcare services. In their view, any other intervention using the heavy hand of the government will only serve to make everybody less happy than they could have been if they were left alone.
Early on, it becomes clear that markets, however well-functioning, do not by design have the ability to provide public goods such as a well-functioning legal system or a pest control programme, which have the general characteristic that it is not possible to deny access to individuals who choose not to pay for them and whose consumption by one does not reduce its availability for another.
As a result, even market purists modified their original position to also include the financing and provision of public goods as a legitimate part of government intervention in the economy. In the context of healthcare, this meant that the provision of services, such as good pest control, sewerage systems, and water purification systems, could be included within the purview of government health expenditures over and beyond cash transfers to low-income families.
However, the purists forgot that for the market to work even for other types of goods, a number of conditions need to be satisfied. Most notably, consumers must have the knowledge and the state of mind to be able to make informed choices, have consumer sovereignty and not let others affect their preferences easily, have the time and resources to shop for alternatives, and that choices exist in the market.
It does not take an Economics PhD to figure out that many of these conditions are not satisfied in most situations related to healthcare. Besides, how often are prices and quality known before patients have to make their choices.
Further, recent studies have shown we as human beings do not worry about the future as much as we rationally should hyperbolic preferences and that we are unable to fully comprehend both, our own health status, particularly in the context of non-acute diseases, such as diabetes and high blood pressure, and the complex advances in the science of healthcare, which even as we speak, continue to happen at a faster and faster pace.
We all know that despite being in the best of health, there is a possibility that any one of us could have a serious accident or have a mutation in our genes resulting in cancer. Medical science knows how to treat these rare diseases but the treatments are very expensive and can lead to catastrophic levels of expenditures for families.
The mechanism of health insurance offers an obvious market-based solution. In some cases, a health insurance agency might also play a role to fill the knowledge gap between the provider and the patient.
The purist view is that since such a solution is available and individuals are free to purchase it, no intervention by the government is necessary.
However, because as human beings we characteristically undervalue insurance when we are healthy, there is an inadequate demand for such voluntary insurance. And, even if people demanded it, the market worked against them because insurers worked hard to exclude those who needed insurance the most.
A view, therefore, began to gain currency that the government needed to intervene either to require that everybody buy such insurance or to use some of its tax resources to do this for the poor instead of handing over the amount to them as direct cash benefit transfers.America's health-care system is larger than the entire economy of France; it's also one of our least effective markets.
Sep 09, · Brief history of quality movement in US healthcare. The current healthcare quality improvement infrastructure is a product of a century long experience of cumulative efforts.
It began with an acknowledgement of the role of quality in healthcare, and gradually evolved to encompass the prioritization of quality improvement .
A bad idea to improve quality is a government-run “pay for performance” system. In theory, it is an excellent idea.
Oct 25, · The National Health System in the UK has evolved to become one of the largest healthcare systems in the world. At the time of writing of this review (August ) the UK government in its White Paper “Equity and excellence: Liberating the NHS” has announced a strategy on how it will.
- HEALTH CARE SYSTEM IN JAMAICA INTRODUCTION Health policy refers to decisions, plans and actions used by governments in achieving specific health care goals within society. the audience grows with hatred towards America’s healthcare system and ends up demanding for a universal health system that would help other .
Read chapter 3 Coordinating the Roles of the Federal Government to Enhance Quality of Care: The federal government operates six major health care programs Login Register Cart Help Leadership by Example: Coordinating Government Roles in Improving Health Care Quality ().