COUNTERPOINT:Integrating CQI in Health Organizations: Perspectives

Abstract

Control of health care expenditures has become a major issue for most nations, especially for industrialized countries. All of them try to optimise the quality of the health care delivered and to reduce costs, while integrating all the new technologies developed. As of today, this challenge has not been met by any health care administration. Consequently, mechanisms of regulation are changed frequently and patients do not always understand the logic associated with these policy changes. To preserve their confidence in the health care system, patients require from health care professionals proofs of efficiency and assurance of quality. Modern methods of quality management aim to respond to these needs. In this issue. Professor Stem highlights the new difficulties encountered by Israeli public health care organizations. Hospitals are facing a competitive environment based on economic constraints and the need for a client-oriented strategy. This is not significantly different from the current situation in France: public hospitals (under the global budget principle) have to compete with private hospitals which are numerous (more than 70% of all French hospitals) but usually small (they represent less than 30% of the total number of beds). Moreover, it appears that nowadays some public hospitals also have to compete against each other. This competition has often led to a better response to patients' needs by the provision of more technical and specialized services, but at the same time, it has become difficult for health care administrations to control quality of care. However, the hospital environment in France will change following implementation of the recent health care reform elaborated by the current Government. Among other changes, accreditation of hospitals will be required. This new requirement could be a handicap for the development of CQI