Government, like doctors and hospitals, should meet quality standards

Performance measurement is a first step towards quality improvement in health care. When systems are in place to measure performance we can reward good performance, develop and evaluate ways of improving performance, and certify (or decertify) providers who perform (or don't perform) according to established standards. In the United States an extensive machinery has emerged to measure and ensure performance, but so far it has not been applied systematically to public health agencies. That situation is about to change, and, as it does, it opens up the interesting possibility of holding elected politicians even more accountable for decisions that affect health.

Efforts to measure the performance of healthcare providers in the US have expanded rapidly over recent years. Much of this activity has been driven by the main purchasers of health care—large employers and government.1 The Joint Commission on Accreditation of Healthcare Organizations accredits 18 000 facilities in the US, including hospitals, home care agencies, long term care facilities, and clinical laboratories, allowing them to participate in the federal Medicare programme for the elderly.2 The performance of health maintenance organisations is assessed through “report cards”—especially the health plan employer data and information set3—and through accreditation by the National Committee for Quality Assurance.4Doctors …