Managing by Numbers
This chapter examines the role of quality measurement within market-based health policies. Quantifying quality is supposed to unite regulators, health plans, and health care consumers in a circuit of constant improvement. Additionally, the production of quality data is important in the Medicare program as patients are supposed to use quality statistics to make informed plan choices. The chapter first analyzes policy documents that define the methods and administrative rationale for conducting quality measurement. It draws on the ethnographic research conducted at Acme. Much of the observation done was targeted at maximizing revenue and complying with regulatory requirements. The chapter concludes with interview excerpts from health plan members regarding how they imagine quality health care, thereby demonstrating some of the disconnects between the quality-measurement efforts of policy makers and health maintenance organizations (HMOs), and the kinds of quality concerns raised by consumers.
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