Commentary: Quality and Managed Care: Where Is the Fit?

Abstract

Quality in health care is broad, complex, and not eas ily measured. This essay explores the many dimensions of quality in health care and shows that many under standings of it are narrowly configured to the agendas of the respective participants—providers, patients, and institutions-in today's health care arena. Also, there are many aspects of quality that defy measurement in the epidemiological sense. These are seen in the physi cian-patient relationship and in special clinical situa tions, such as the process of dying. Using the idea of quality to buttress ethical and policy decisions, partic ularly by managed care organizations, is often problem atic, given this complexity. It is thus imperative that those so using quality be accountable that their under standing of it be arrived at by responsible means, that it addresses something meaningful, and that it not eclipse the many other dimensions of quality.