Employers: Quality takers or quality makers?

This article provides a synthesis of past research to help understand the e xtent to which employers are using their considerable market pouter to driv e health care quality Are employers quality takers or quality makers? The l iterature provides some clues about aspects of quality employers are attemp ting to influence, strategies they are pursuing to influence qualify, and t heir impact. Some employers are interested in some indicators of quality an d are incorporating them in a variety of different purchasing strategies. T he indicators most frequently used by employers, however, probably are nor the ones that clinical experts and policy makers would select as most refle ctive of clinical qualify. It appears that employers as a group are becomin g more informed quality takers but are not yet quality makers-with the exce ption of a few well-resourced outliers. Recent events provide mixed signals about whether the future employer role in influencing quality will diminis h, stall, or flourish.