ABSTRACT

High quality in medical care is popularly exemplified by things like a startling new kind of brain surgery, or our ability to keep alive ever-smaller infants, or a breakthrough antibiotic. As health plans compete for employer contracts and employers try to please employees, medical outcomes and patient satisfaction are two of the most discussed indicators of quality. Patient satisfaction is now offered as an alternative litmus test to medical outcomes - at least by managed care companies whose patient surveys show high approval ratings. International comparisons are of interest to policy wonks, comparative political scientists, and public health officials. But they did not cause the national angst about cost that has developed over the rapid pace of US health cost increases in the past three to four decades.