Quality of Medical Care Delivered to Medicare Beneficiaries

Abstract

As concern grows that attempts to control the cost of health care will crowd out quality, evidence has also emerged that quality of care is and has been far more uneven than previously recognized. The public health report entitled Healthy People 2010¹ showed wide gaps between public health performance goals and actual achievements on many measures, including some delivered by the fee-for-service (FFS) health care system. Reviews, most notably by Schuster et al,² showed that there were major gaps in acute, chronic, and preventive care almost everywhere that studies have been done. More recently, a report from the Institute of Medicine showed serious problems of harm to patients from medical errors.³ This kind of evidence was reflected in the recommendation of a recent presidential commission that quality of health care should become a major national priority.⁴ Despite condition-specific and managed care–specific reports, there has been no systematic program for monitoring the quality of medical care provided to FFS Medicare beneficiaries.