Public accountability for health: new standards for health system performance

This article reviews the failure of contemporary quality oversight organizations to respond to the changing health care environment and suggests an overhaul of quality measurement and assurance functions. The authors examine the factors that have limited public accountability for health care, emphasizing the limited agreement that exists on the purpose of American health care, standards for evaluating care, or the appropriate locus of responsibility for quality of care. A five-part quality oversight system is proposed including development of quality measures, promulgation of national standards, validation and accreditation, use of data for purchasing and provider selection, and use of data for quality improvement.