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Quality, cost, and clinical decisions.

A Donabedian

    The Annals of the American Academy of Political and Social Science
    |June 10, 1983
    PubMed
    Summary

    Defining healthcare quality involves balancing patient benefit and harm, considering individual patient values, and acknowledging societal costs. This abstract explores various professional responses to these complex quality definitions.

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    Area of Science:

    • Health Policy
    • Medical Ethics
    • Health Economics

    Background:

    • Clinical decisions involve setting care objectives and choosing strategies.
    • Optimal strategies balance expected benefits against harms from interventions.
    • Current practices often prioritize patient well-being over monetary costs, defining quality in an absolutist manner.

    Purpose of the Study:

    • To explore the multifaceted definitions of healthcare quality.
    • To examine the conflict between individual and societal perspectives on quality.
    • To categorize the responses of healthcare professions to these definitional conflicts.

    Main Methods:

    • Conceptual analysis of healthcare quality definitions.
    • Examination of differing valuations of outcomes and costs (individual vs. social).
    • Categorization of professional responses to quality definition conflicts.

    Main Results:

    • Healthcare quality can be defined absolutistically, individually, or socially.
    • Individual definitions incorporate patient values, costs, and practitioner relationships.
    • Social definitions include broader societal costs, externalities, and distribution.
    • Healthcare professions exhibit diverse responses to quality conflicts: evasion, rejection, confrontation, anticipation, advocacy, complicity, and ambiguous adaptations.

    Conclusions:

    • Healthcare quality is a complex concept with competing definitions.
    • Reconciling individual patient needs with societal resource considerations is a key challenge.
    • Understanding professional responses is crucial for improving healthcare quality and policy.

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