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SELECTING HEALTH CARE SERVICES: QUALITY AND MALPRACTICE
The U.S. health care system employs several mechanisms for ensuring quality services overall: education, licensure, certification/registration, accreditation, peer review; and, as a last resort, the legal system of malpractice litigation. Some of these mechanisms are mandatory before a professional or organization may provide care, whereas others are purely voluntary. (Consumers should note that licensure, although state mandated for some practitioners and facilities, is only a minimum guarantee of quality.) Insurance companies and government payers may also require a higher level of quality by linking payment to whether a practitioner is board certified or a facility is accredited by the appropriate agency. In addition, most insurance plans now require prior authorization and/or second opinions as means not only to reduce costs but also to improve quality of care.
Many people believe that malpractice is a leading cause of our health care crisis. Yet the U.S. Department of Health and Human Services estimates that the total cost of malpractice is less than 1 percent of total health outlays. However, these figures do not account for the previously described practice of defensive medicine. Defensive medicine not only costs money and places patients at additional risk, but it has also changed the standards of care in that people have come to expect these extra, but unnecessary, tests and procedures.
Consumer, provider, and advocacy groups have begun to focus on the great variation in quality as a main problem in our health care system. A newer form of quality measurement uses \"outcome\" as the main indicator for measuring health care quality at the individual level. With outcome measurements, we don\'t look just at what is actually done to the patient but at what subsequently happens to the patient’s health status or health condition. Thus, mortality rates and complication rates (such as infections) become very important statistics in assessing individual practitioners and facilities.
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GENERAL HEALTH
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