A vision for world-class quality in health care

When we talk about world-class health care, we are finding that we are in a position where the purchasers of our services find there is little or no value for the health-care dollars they are spending. Even the father of American Quality, W. Edwards Deming, has listed the high cost of health care as one of the seven deadly diseases, so we know that we are in trouble. According to a 1989 study, the public tells us that 32% of the time the value of health care they receive is good to excellent, and 65% of the time it is fair to poor. When we look at what our physicians say, 76% of them believe that we get good value for health-care dollars as opposed to 23% who think it is fair to poor. As I have been thinking about what world-class quality would mean, one of the things that comes to mind is the fact that health care is now consuming 15% of the gross national product. We are approaching an expenditure level of one trillion dollars. If our results were good, we could feel comfortable resting on our laurels, because for those we serve in the American health-care system, we serve them very well. But our results are not good. We are 23rd in the world in infant mortality, and we are 16th in the world for life expectancy. The real tragedy in the American health-care system is that 37 million Americans are uninsured. Obviously this cannot continue.(ABSTRACT TRUNCATED AT 250 WORDS)