QUALITY IN CONSUMER-DRIVEN HEALTH SYSTEMS

In the global quest for improved 'quality' in health care, the purely clinical quality of health care should not be confused with the qualit y of the health care experience. Although the former is central to the latter, it is the latter that determines the overall quality of a hea lth system. Americans have long had trouble with this crucial distinct ion. A survey of several distinct dimensions of the quality of the ent ire health care experience, for example, can help to explain why the t echnically sophisticated, expensive and often very luxurious American health system tends to earn relatively low scores in cross-national su rveys in which respondents are asked to rate the overall quality of th eir health system. Many useful insights can undoubtedly be had from th e system's myriad experiments with continuous improvements in the clin ical quality of health care (just as Americans, however, could learn f rom similar experiments abroad). On the other hand, the bewildering an d ethically dubious financial and managerial systems that Americans ha ve put in place to foster continuous quality improvement in their heal th care may be self-defeating in the end. Policy analysts and policy m akers in other countries may learn from the American experience to spa re their citizens the agony.