Quality of care for women: where are we now and where are we headed?

Abstract

The pursuit of solutions to the problem of rising health care costs has given rise to innovations in the organization and financing of medical care. A common thread across many of these innovations is the imposition of limits on choice through the structure of benefit packages, the choice of insurers, the choice of doctors and hospitals, and the availability of treatment alternatives. Limits on choice have raised concerns about quality, particularly the underuse of medically necessary procedures and the availability of qualified providers. Although these quality concerns have been identified within the research community for decades, along with problems related to overuse and errors in medicine, their recognition among purchasers and consumers is more recent. Perhaps the most visible sign of the importance of these concerns is the increased demand for, and provision of information about, quality within a framework that requires accountability for health care spending. This accountability framework has been applied most systematically to managed care organizations, but it eventually will spread throughout the health care system.