The rapidly changing health care delivery system in the United States has led to renewed interest in the quality of medical delivery, which has been in some part due to the rise in the number of patients enrolled in managed care.1 The development of health maintenance organizations (HMOs) promised reduced medical costs and improved quality. Managed care companies have reduced the cost of medical care, mainly by reducing hospital admissions, reducing the length of hospitalization, and requiring preapproval for high-technology procedures.2 How managed care has affected quality is less well documented; at least in some instances, managed care has led to a reduction in quality.3 Who and what defines quality is often a difficult question. The measurement of quality depends on several factors, including who is doing the measuring and what factors they are measuring. For example, if physicians are measuring quality, they are likely to measure
Kirsner RS, Federman DG. Patient Satisfaction: Quality of Care From the Patients' Perspective. Arch Dermatol. 1997;133(11):1427–1431. doi:10.1001/archderm.1997.03890470105017
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