Lessons learned from five years of measurement of health care quality

Extract

In the Netherlands in the past five years, a lot of energy has been devoted to the development of quality indicators that should serve multiple purposes: consumer choice, selective contracting by health insurers, quality improvement and quality regulation. Authors from various backgrounds discuss the extent to which this has been successful and offer advice for future indicator development. In the past years it has become clear that it is difficult to reach consensus about indicators that serve all the purposes mentioned above. For quality improvement, managers and professionals need rather detailed information about the process of care, but for consumer choice and selective contracting, patients and health insurers need information about the outcome of care. Health insurers and patient/consumer organisations together should take the lead in defining what kind of information they need in order to fulfil their role as critical consumers, respectively contractors. However, some health insurers promote their brand by explicitly advertising that they will not act as selective contractors and leave the choice of provider to individual enrolees, who are deemed capable of making their own decisions. In addition to that, the information infrastructure of the Dutch healthcare system poses difficulties, because it is not designed to allow valid and reliable data collection about the quality of care. …