Title: Redefining quality by reassigning responsibility. (Quality
of Care and Health Reform: Complementary or Conflicting)
Citation: American Journal of Law & Medicine, Spring-Summer 1994 20
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Subjects: Medical care_Quality control
Medical care, Cost of_Analysis
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Abstract: Responsibility for defining medical care quality, delivering quality medical care and bearing the burden of liability for lack of quality needs to be refocused away from the physician and vested with health care plans, patients and payers. Placing decision-making in the hands of individuals that did not have to face cost constraints has resulted in highly interventionist care that has become too costly. Patients, who ultimately pay for health care directly or indirectly, have been separated from the decision-making process by medical professionals and health care plans.
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Full Text COPYRIGHT American Society of Law & Medicine Inc. 1994
Implicit in any discussion of quality in health care are ideas about responsibility: who is responsible to define quality, who is responsible to deliver it, and who is responsible when the quality of care is unsatisfactory. The thesis of this article is that due to economics, ethics, and law, we have placed these responsibilities almost exclusively on physicians, but that powerful economic changes now require a reallocation of the responsibilities of providers, patients, and payers in defining and delivering quality in health care.
In the past half-century an extraordinarily generous, uncritical reimbursement system has empowered physicians to define and deliver quality that is interventionist and highly technological. Longstanding ethical precepts hold that physicians are respo...