organizations to develop procedures that will lead to more effective and more efficient operations. The improvement of quality in all aspects of a health care institution's activities has been linked to this goal. The need to improve quality and control costs is especially applicable to health care institutions receiving public financial support. Proposed national health care reform, increased consumer demands for quality health care, and public outcries for the control of health care costs are issues that must be addressed by all health care institutions in both the public and private sectors. Budget reductions and increased attention to the efficiency and effectiveness of governmentally provided services of all types are added pressures for health care institutions receiving public funding. The development of effective approaches to the solution of the problems associated with this issue, however, is a difficult task.
Improving the quality of the care provided is widely suggested in the 1990s as the solution to the problems being faced by health care institutions. While medical professionals have no quarrel with striving for high quality health care, many of these individuals do tend to reject initiatives that appear to be further manifestations of codified bureaucratic machinations that likely will have no long lasting positive impacts on the quality of health care services.
Seemingly countless numbers of techniques were proposed in the late 1970s and early 1980s to be employed in the control of health care costs. Of all the techniques proposed, however, five gained the greatest acceptance, and each has had a significant impact on decision prerogatives with respect to hospital selection. These five were the prospective reimbursement system (PPS); hospital utilization review; pre need contracted services, manifested primarily as health maintenance organizations (HMOs), hospital managed corporations (HMCs), and ot...