Monitoring Quality of Care in the Medicare Program

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Abstract
TWENTY years ago, when much of the methods work in quality assessment began,1an age of optimism about the provision of health services in the nation appeared to have dawned. Resources seemed unlimited, and legislation to increase access to services for the underserved was at last being enacted. Measures of quality and health status were seen as crucial aids in knowing where to put additional funds to make Americans as healthy as possible, and it was believed that more resources would be available to develop the best possible methods for assessing quality and health status. As we now know, events did not unfold as had been so expansively expected. Even as access to care improved, costs of health care escalated beyond all imagined levels. In this environment, the field of quality assessment did not flourish as its proponents had hoped. Apparently unlimited resources and rapid technologic changes were, perhaps,

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