ABSTRACT
The quality of healthcare in the United States is of national concern. A wake-up call for health system change was provided by the Institute of Medicine (IOM) in its landmark report, To Err Is Human: Building a Safer Health System (2000), which estimated that between 44,000 and 98,000 people die each year because of medical error. In a follow-up report, the IOM stated:
Major challenges in healthcare quality are affecting patients, families, and providers and resulting in poor clinical outcomes. The United States ranks last out of the industrialized countries on preventable mortality. For 37 core indicators of performance, the United States attains an overall score of 65 out of a possible 100 when comparing national averages with U.S. and international benchmarks. These poor outcomes occur despite the United States spending 16% of its gross national product (GNP) on healthcare-a percentage larger than any other country (CMS 2008). U.S. health insurance administrative costs are 30-70% higher than in countries with mixed private/public insurance systems (Commonwealth Fund 2008). In addition, more than 5% of healthcare expenditures are a result
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of fraud and abuse, such as billing for services not rendered or inaccurate coding and billing (Ingenix 2004).
