Capturing Quality?: The Quality Issue in British and American Health Policies

ABSTRACT The quality of health care services has recently become a prominent political issue in both Britain and America. Everyone is in favour of quality. Yet closer inspection reveals that the term is being used with several different meanings, and that its fashionability seems intimately connected with the collision, in both countries, between rising health care costs and a desire on the part of the purchasers or paymasters of health services to restrict their expenditures. The different approaches to assessing quality are not neutral, technical matters. Each carries implications for the future relationships among health care providers, and between providers, payers and patients. Furthermore, changes in these institutional relationships may well lead the debate back to the larger, traditional and more obviously ‘political’ issues of resource allocation, equity and the role of the state.

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