The quality improvement movement has changed its focus from improving the health of patients to obtaining the greatest return for the investment.  Why? Because experience has shown, time and again that the former is beyond our abilities, beyond any 'carrot and stick' approach to patient care, and beyond any contrived incentive realignments.  When it comes to lifestyle management, we fail, miserably.  For instance, getting people to stop smoking, the only thing that has worked is raising the pric

The main tension about healthcare centers around medical need, quality, access and cost-efficiency, i.e., affordability. To increase "value," one must raise quality, improve access and/or lower the cost of care. 

The modus operandi in managing care is that 'one cannot manage what one does not measure and the obverse, one cannot measure what one does not manage.' Consider the final equalizer in health care method comparisons—outcomes….who's measuring? Who's managing?  

Much of the work on health disparities and inequities in access focuses on comparisons between the insured and those without coverage; the uninsured come out wanting.  [Surprise] “Uninsurance is associated with mortality.” Uninsured persons have less access to services and suffer worse health outcomes than those insured. Breast Cancer patients suffer with a 30-50% higher mortality rate Accident victims have a 37% greater mortality rate (1)