[Quality of health care and its evaluation]

The focus on quality improvement of health care has been emerging in last decade, due to rapidly increasing competition, cost containment by governmental and private health financing corporations (including health insurance), and high costs structure of health care providing institutions. Accordingly, necessity of evaluation on results of care/outcome (discharge and discontinuation) of care has been drawn prompt attention of decision makers and administrators in health care institutions. However, since, original motive of quality care has been generated from the aspect of care providers' oriented (in US: Market and costs oriented, in Europe: Legislation oriented) bases and directions, in terms of cost performance, downsizing operation, improvement of competing capability and creating new profit making opportunity, evaluation approach, prioritization, itemization, setting goal, and standards were forced to set as forth to meet the providers' objective, in stead of patient's benefit and maximization of patient's satisfaction. Therefore, effective evaluation structure of quality balance management in operation must be built and consisted of four major 1)-4) cores to maintain patient oriented quality and optimal level of quality obligation to community. 1) In process 2) In Services 3) In Inhabitant Benefits 4) In Producing Assured Results. Through the efforts, it is proposed to urge "Evaluation Effectiveness Initiative (EEI) by Japan's leadership" to achieve sustainable safety and effective quality in balance of process through whole operations.