Defining Quality in Medical Care

Prologue: The quality of medical care rendered by physicians in and outside of hospitals has become a subject of increasing public and, more recently, private-sector concern. Until quite recently, third-party payers were reluctant to question the medical decisions of physicians, recognizing that medicine is a complex equation and that one of the hallmarks of a profession is self-regulation. Beyond the issue of professional autonomy, though, is the reality that “quality” is defined differently by different interests. In this paper, Philip Caper discusses the evolution of federal involvement in the pursuit of quality, noting that organized medicine has never been bashful about employing the quality argument in an effort to thwart health policy thrusts that it opposed. Caper is well equipped as a physician and a policy analyst to discuss issues revolving around the quality of care. He was a professional staff member of the Senate Labor and Human Resources (then Labor and Public Welfare) Subcommittee on Health and Scientific Affairs (1971 to 1976) and vice-chancellor for health affairs at the University of Massachusetts and chief of the medical staff at the institution's teaching hospital in Worchester (1976 to 1980). During the early 1980s, he was a research fellow at Harvard University's John F. Kennedy School of Government. He currently is a professor of public policy at Dartmouth Medical School and president of the Codman Research Group, Inc. Codman and the American Medical Review Research Center are engaged in an eighteen-month project to conduct the first comprehensive, nationwide analysis of the costs and utilization of local hospital services by Medicare beneficiaries. The work, undertaken for the Health Care Financing Administration, is a part of the agency's effort to employ Medicare's vast database to measure the performance of providers who render care to the program's beneficiaries. Caper believes that the development of this statistical information will offer the medical profession a new opportunity to strengthen its participation in the evolution of federal health policy.