Quality and the Medical Marketplace — Following Elephants

Suddenly, “quality” has become the watchword among those who care about the American health care system, and attempts to measure it are giving rise to a whole new industry. Just three short years ago, during the debate about the Clinton plan for reforming the health care system, quality was a secondary issue. The emphasis instead was on providing universal access to health care in a national system designed to contain costs. Now, access seems all but forgotten (even while it shrinks precipitously), and costs are considered not systemwide, but by individual payer groups. Quality and accountability are the focus of . . .