It gets better if you do? Measuring quality care in Puerto Rico

Quantifying quality is supposed to unite health policy, health plans, and health care consumers in a circuit of constant improvement. In practice, significant gulfs separate how policymakers, health plan administrators, and consumers write and talk about quality. Drawing on policy literature, ethnography inside a managed care organization, and interviews with health plan members, this article examines a quality improvement program at a health plan in Puerto Rico. The findings challenge the assumption underwriting neoliberal health policy that quality measurement leads to quality improvement.