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Accountability for quality in managed care

M S Donaldson1

  • 1Institute of Medicine, Washington, DC, USA. mdonalds@nas.edu

The Joint Commission Journal on Quality Improvement
|December 30, 1998
PubMed
Summary
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A model for managed care quality accountability was developed, integrating professional, market, and regulatory approaches. This framework addresses challenges in assigning responsibility and ensuring quality improvement in healthcare organizations.

Area of Science:

  • Health Services Research
  • Quality Improvement Science
  • Healthcare Management

Background:

  • Managed care organizations (MCOs) face challenges in defining and enforcing quality accountability.
  • A model was developed by the National Roundtable on Health Care Quality to address these accountability gaps.

Purpose of the Study:

  • To present a model for accountability for the quality of care in managed care organizations.
  • To explore the interplay of professional, market, and regulatory accountability mechanisms.

Main Methods:

  • Development of a conceptual model for quality accountability.
  • Analysis of professional, market, and regulatory accountability tools and sanctions.
  • Consideration of public goods and inter-organizational collaboration.

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Main Results:

  • Identified three primary forms of accountability: professional, market, and regulatory.
  • Highlighted limitations in each accountability form, such as weakened professional autonomy and lack of consumer information.
  • Emphasized the need for regulatory structures to correct market failures and ensure public goods provision.

Conclusions:

  • Effective quality accountability in managed care requires a multifaceted approach involving multiple entities and accountability types.
  • The three forms of accountability (professional, market, regulatory) are interactive and operate concurrently.
  • Collaboration among MCOs and leadership from health professions are crucial for quality improvement.