Health policy and quality: an ethical dilemma

Emergency medicine is on the front line of many important health issues, such as access for the poor and uninsured, the AIDS epidemic, and domestic violence. Virtually all key policy issues relating to emergency medicine deal with the concept of quality. During the 1970s, quality issues dealt with issues of value. Interest in quality is now vested in the tradeoff between cost containment activities and preserving access to health care. Key definitions of efficacy, effectiveness, and efficiency are provided. A policy approach to quality definition and assessment is suggested based upon the concepts of continuous quality improvement. The role of emergency physicians in health policy and the future of emergency medicine are discussed.