Promises and pitfalls of ensuring health care quality

On the surface, quality assurance and quality improvement appear to have similar objectives; however, the purpose of each is fundamentally different. This paper discusses these two frequently confused approaches to quality in health care, identifying the primary objective of each and clarifying which approach should be used for various situations. Past and present issues, including questions such as, "What should a health plan's role be?" and "What does the public want?" are explored using examples and study results. A California quality scoreboard project is also discussed, including the initial process of ranking plans and the difficulties encountered in attempting to publicize the data. Finally, areas of consensus and debate are addressed.