The lowest measurement costs arise with structural criteria, such as measuring
health care providers’ qualifications. Another advantage is their availability
before the diagnosis and treatment process begins. The quality of the process
itself can also be measured. In line with Akerlof’s argument, for example, health
care providers can signal their quality provision by offering guarantees to adopt
state-of-the-art, evidence-based guidelines for treatment. While information
about such process criteria is available before diagnosis and treatment, measurement
costs are typically higher than for structural criteria. High measurement
costs also occur when measuring outcome quality. We have another problem
here: ex-post knowledge of quality parameters – e.g. typically, complication
rates – are only available with a noticeable time lag after diagnosis and treatment,
and they have to be risk-adjusted (e.g. Matthes and Wiest, 2005: 65).
Based on these health care quality standard dimensions and the two basic
approaches (regulation or competition), the subsections below outline a proposed
framework for quality assurance. We start with a discussion of available
instruments and potential actors that could be responsible for their application,
before finally outlining a feasible assignment of actors and duties within a
health care system embedded in a social market economy
The lowest measurement costs arise with structural criteria, such as measuringhealth care providers’ qualifications. Another advantage is their availabilitybefore the diagnosis and treatment process begins. The quality of the processitself can also be measured. In line with Akerlof’s argument, for example, healthcare providers can signal their quality provision by offering guarantees to adoptstate-of-the-art, evidence-based guidelines for treatment. While informationabout such process criteria is available before diagnosis and treatment, measurementcosts are typically higher than for structural criteria. High measurementcosts also occur when measuring outcome quality. We have another problemhere: ex-post knowledge of quality parameters – e.g. typically, complicationrates – are only available with a noticeable time lag after diagnosis and treatment,and they have to be risk-adjusted (e.g. Matthes and Wiest, 2005: 65).Based on these health care quality standard dimensions and the two basicapproaches (regulation or competition), the subsections below outline a proposedframework for quality assurance. We start with a discussion of availableinstruments and potential actors that could be responsible for their application,before finally outlining a feasible assignment of actors and duties within ahealth care system embedded in a social market economy
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