Summary

Pursuant to a congressional request, GAO reviewed health care quality assurance issues that would arise from expanding health care coverage to the uninsured, focusing on the need for a national quality assurance strategy.

GAO found that: (1) the concept of health care quality involved varying perceptions among patients, providers, and purchasers; (2) quality assurance, unlike quality assessment, often required behavioral changes to improve quality or prevent poor quality from occurring; (3) health care system design, including health care accessibility and administrative requirements, influenced quality assurance; (4) a comprehensive national strategy for health care quality assurance would ensure equitable care, regardless of the financing source; (5) health care providers' internal commitment to improving health care quality should be balanced with external organizations' monitoring of general quality levels; (6) the development of practice guidelines and standards was an important factor of comprehensive quality assurance; (7) an effective comprehensive quality assurance system would require an enhanced data system for monitoring health care practice patterns, regardless of the health care setting or provider; (8) a national organization would improve the local quality assurance review system by developing guidelines and review methods and overseeing local review activities; (9) accreditation and certification programs should be expanded to private practices; and (10) consumer education would be needed to assist new patients in using the health care system.