Quality improvement in an era of payment reform

As Russia responds to the imperative of implementing payment reforms, careful attention must be focused on the protection and enhancement of the quality of patient care. New contracts that specify the relationship between purchasers and providers of health care services should not be limited to defining levels, frequency, and methods of payment. These documents must also clarify mutual expectations as to which indicators will be used to measure quality, as well as the frequency and methods to be used in measuring and reporting on issues of quality. These new contracts also need to emphasize that the quality of health services will now be assessed not only on the basis of traditional measures focusing on the process of care, but also in terms of clinical outcomes and patient satisfaction.