Abstract
Independent accreditation is the third component of comprehensive regulatory systems of countries with a mixed economy of healthcare provision such as the United States and Australia. Now that the Health and Social Care Act 2013 is fueling more pluralistic provider and commissioner models in England, this article explores the case for requiring all suppliers of publicly funded healthcare to be formally accredited. In doing so, it sets out the benefits of independent accreditation, describes the international market including the UK-based accreditation bodies, lists some NHS providers who have already opted to be accredited and sets out a proposed way forward based on the recent experience of South Africa.
Keywords
Get full access to this article
View all access options for this article.
References
1.‘So called regulators have been of singular irrelevance …’ Quote attributed to Dr. William Pickering, in Private Eye, number 1345, page 12 .
2.United Nations Industrial Development Association. ISO 9001 – its relevance and impact in Asian Developing Economies. Vienna: Author, 2012 .
3.In Australia most working age adults are required to take out private health insurance to cover elective care, emergency and primary care being publicly funded .
4.Drawn from Accreditation of healthcare providers: Econex, Health Reform Note 2, RSA, July 2010, www.econex.co.za/images/stories/ECONEX_Health%20Reform%20Note_2.pdf (2010, accessed 23 June 2014) .
5.The Care Quality Commission (CQC) is a non-departmental public body of the United Kingdom government .
6.www.ukas.com (accessed 23 June 2014) .
7.www.ukas.com/aboutaccreditation/What_is_Accreditation/What_is_Accreditation.asp (accessed 23 June 2014) .
8.Argawal R. A guideline for quality accreditation in hospitals. Inside Health Care , www.qualitydigest.com/inside/twitter-ed/guideline-quality-accreditation-hospitals.html (2010, accessed 19 May 2010) .
9.Accreditation of healthcare providers: Econex, Health Reform Note 2, RSA, July 2010, www.econex.co.za/images/stories/ECONEX_Health%20Reform%20Note_2.pdf (2010, accessed 23 June 2014) .
10.See for example, www.carf.org/Accreditation/AccreditationProcess/StepstoAccreditation and www.jointcommission.org/ (accessed 23 June 2014) .
11.World Health Organisation. Quality and accreditation in health services: a global review . Geneva: WHO, 2003, p.41 .
12.In their review of the literature on accreditation, Tabrizi et al. concord with WHO that the US predominantly and Australia and Canada lead the OECD in the implementation of accreditation in the healthcare area. (Tabrizi RS, et al. Advantages and disadvantages of health care accreditation models. Health Prom Perspect 2011; 1: 1–31 .
13.Centre for Medicare and Medicaid Services, ‘Section 1865 (a) exemption’ from otherwise mandatory state inspections and surveys, www.cms.gov/medicare/provider-enrollment-and-certification/surveycertificationteninfo/accreditation.html (accessed 23 June 2014) .
15.Sharing of information, lack of transparency and the temptation for providers to withhold information from regulators being key issues identified in the Grant Thorton Report: The Care Quality Commission re: Project Ambrose, dated 14 June 2013 p.7 para 1.21 .
16.www.telegraph.co.uk/news/politics/10228052/Why-a-culture-of-fear-and-blame-wont-fix-the-NHS.html (accessed 23 June 2014) .
17.The projected US federal government healthcare expenditure alone for 2014 is $1012 bn for a population of 314 million, equivalent to a per capita spend of £2,300 per year compared to around £105 bn for 56m population or £1875 per head in England. State funding of health care is additional so that total public spending equates to 45% of all health care expenditure now approaching $3 trillion. Congressional Budget Office, The Budget and Economic Outlook: Fiscal Years 2010 to 2020; www.cbo.gov/publication/41880 (accessed 23 June 2014) .
18.Centre for Medicare and Medicaid Services op.cit. Section 1865(a)(1) of the Social Security Act (the Act) permits providers and suppliers ‘accredited’ by an approved national accreditation organization (AO) to be exempt from routine surveys by State survey agencies to determine compliance with Medicare conditions .
19.The Centre for Medicare and Medicaid Services .
21.www.dnv.com/binaries/DNV%20brochure%20%20Final%20%2023%20Aug%202012_tcm4-535588.pdf (accessed 23 June 2014) .
22.Healthcare Effectiveness Data and Information Set, www.ncqa.org/HEDISQualityMeasurement.aspx (accessed 23 June 2014) .
23.www.ncqa.org/Programs/Accreditation.aspx (accessed 23 June 2014) .
24.www.chks.co.uk/Assurance-and-Accreditation (accessed 23 June 2014) .
25.www.qha-trent.co.uk/#!medical-tourism-and-accreditation/c1xj6 (accessed 23 June 2014) .
26.Not everyone on the private provider side sees the need to go beyond the current system. For example, the website of UK Treatment which promotes health tourism in the UK to the United States claims that the CQC: is the equivalent of the Joint Commission which accredits hospitals and clinics in the USA and internationally. In the UK, there are no JCI accredited hospitals. Why not? Because the standards set by the UK's Care Quality Commission either match or exceed those set by the US domestic and international accreditation bodies. www.uktreatment.com/why-the-uk/hospital-accreditation/ (accessed 23 June 2014) .
27.United Nations Industrial Development Association. ISO 9001 – its relevance and impact in Asian Developing Economies . Vienna: UN, 2012 .
28.Sack C, et al. Is there an association between hospital accreditation and patient satisfaction with hospital care? A survey of 37000 patients treated by 73 hospitals. Int J Qual Health Care 2011;23:278–283 .
29.Cochrane DA. Managed care and modernisation . Oxford: OUP, 2001, p.17 .
30.Sack C, et al. op cit .
31.Hinchcliff R, et al. Narrative synthesis of health service accreditation literature. BMJ Qual Saf 2012;21:979--991. doi:10.1136/bmjqs-2012-000852 and Hincliff et al., and Evaluation of current Australian health service accreditation processes; (protocol for a mixed-method research project) BMJ Open 2012;2:e001726. doi:10.1136/bmjopen-2012-001726 .
32.Frick KD, et al. Substitutive hospital at home for older persons: effects on costs. Am J Manag Care 2009;15:49–56, www.med-ic.org/pdf/HaH_Cost_Paper_AJMC.pdf (accessed 23 June 2014) .
33.www.buckshealthcare.nhs.uk/Default.aspx.LocID-03200100400g008002.RefLocID-032001004003.Lang-EN.htm (accessed 23 June 2014) .
34.www.parkinson.org/home.aspx (accessed 23 June 2014) .
35.www.ukas.com/media-centre/press-releases/Aintree_Hospital_granted_NHS_IQIPS_accreditation.asp (accessed 23 June 2014) .
36.www.ukas.com/media-centre/press-releases/Calderdale_and_Huddersfield_NHS_Trust_Achieve_ISAS.asp (accessed 23 June 2014) .
37.www.imtj.com/news/?entryid82=379273#sthash.VcGzSxhy.dpuf (accessed 23 June 2014) .
38.WHO op.cit .
39.www.ukas.com/media-centre/press-releases/Accreditation_Has_Vital_Role_in_Delivering_Quality.asp (accessed 23 June 2014) .