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November 2007

Premises, Promises: Performance Measures in Health Care

Arch Ophthalmol. 2007;125(11):1566-1567. doi:10.1001/archopht.125.11.1566

Health care in America is in a death spiral.—Bruce Howell, JD, March 5, 2005

There is an emerging sense of “knowing” that American health care is in dire straits. Two premises underlying this belief are driving change: that the system is too expensive and too dangerous. The proof of the first premise is generally proffered by observations that there are too many uninsured Americans, and most of the remainder are increasingly burdened by inexorable increases in the cost of care. Proof of the second seems to derive from reports of medical ineffectiveness and error, such as the report of the Institute of Medicine. In apparent response comes expanded interest in “performance measures” and appraisal. To effect improvement in performance, 2 significant trends are emerging: renewed interest in technology, particularly the electronic medical record (EMR), and accountability among medical providers (witness the calls from Congress for provider proof of “quality indicators” in return for maintaining reimbursement rates for services). These premises are intertwined. The promises implied are that health care will become more accessible and effective if change is accepted. Let us examine these premises in light of the promises and the likely consequential prospects.

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