An in-depth look into the Definition of Quality of Medical Care and current Misconceptions around its True Essence
Quality is relative, as every person has its perception of a better service or a good. Even the same person may or may not characterize the quality as being perfect objectively for somebody else, while at the same instant, he- or she may see it not so good subjectively. The concept of quality becomes even more intricate when applying it in the healthcare domain and medical practice. For that reason, we open the door to so many questions once we start bundling the quality and value of a medical service based on the set factors or criteria, such as country X has better healthcare than country Y, or doing A entails better care for everyone.
Today we are on the fast track towards a value-based healthcare delivery model, so the answer to the questions like “Which country has the best healthcare system in the world?”- has no more weight, as it had when it was a fee-for-service; unless we all, as patients and physicians, agree on some predetermined standards. But is it really what medical care is all about?! Or is it about keeping a patient healthy and happy? — not just physically and mentally but also socioeconomically.
To answer the question of- “Who gets the best Medical Care and where; it requires Defining Healthcare.
The measure of quality in healthcare is delicate, particularly in today’s ever bureaucratized care system. The more we embrace corporate-style medical care, the further we move away from the personal vision of quality and rely solely on the collective determinants of a good deliverable. There are many social determinants of quality of care and health within the 21st-century population health model. They are defined as optimal care, such as maintaining blood pressure or blood glucose below a certain level. That is despite even though such numbers are simply the product of observations by a group of people. As accurate as they may seem, nevertheless are not perfect; “Human health is not absolute, neither is medicine a perfect science.” In general, however, healthcare is the logistics that we can offer at a particular place and era into one specific person in line with the objective determination of the patient’s treating doctor and subjective expectation.
Quality and its Determinants
Quality is an attribute or characteristic of a tangible object or service that sets it apart from its kind. However, defining the highest quality is not as straightforward, especially if we exclude the users or persons directly involved concerning that particular service or the product. Common sense plays a decisive role in defining quality and tends to see quality related to subjective feelings or objective evidence. The rate can also apply to something that depends on the standards being implemented and does not determine its value from a neutral point of view. Someone may perceive something to be good merely because it is functional. After all, it is attractive, or simply because it is there. Then again, identifying quality requires distinguishing what is useful, substantially engaging, and what exists. Commonly, quality can mean a measure of excellence, as in “a quality product” or “work of average quality,” but again, who determines the standard of excellence?
The last question’s answer may be more straightforward once we apply it to a fundamental science such as engineering. For example, a better home may be earthquake-resistant, warm, and in a safe neighborhood, even though it is still not perfect. But the aggressive medical treatment of a dying patient may entail more suffering and pain, hence the low quality. In contrast, the same treatment may seem ideal for a young, otherwise healthy person in a deprived neighborhood.
Relativity of quality and value is factual, more so concerning medical science. But- we seem to be moving away from that notion. We instead are embracing a vision of quality from an economic perspective rather than the actual personal variance.
Subjective and Objective Expectation and Measure of the Country’s Healthcare Quality
Although medical care quality is personal, it is often applied collectively to community standards and even countrywide. Naturally, if the particular community is culturally homogeneous, one should expect a lesser discrepancy in objective and subjective expectations on the quality. However, once the same community diversifies culturally, and public expectations flinch to rise, such standards crumble into fictitious determinants. Then the ultimate bureaucratic solution shall rely on economic criteria rather than personal evaluations.
Once we start generalizing healthcare quality on a country basis and comparing them to each other, we are merely hoping that everyone or the majority will be happy with their medical care. The latter is hardly the case in today’s highly expectant societies. One country may see another as the best- simply because they don’t have what patients in other countries cherish, and vice versa. Let’s say- it seems the grass is greener on the other side! Or furthermore, there is a discrepancy between objective and subjective perception within those societies or in a person’s mind. For instance, someone residing in the country without the 3rd party payer system may see national healthcare coverage as a measure of high quality. Still, the latter patient may feel national healthcare is failing him simply because he has to be on a long waiting list to get elective surgery.
Objective and Subjective Quality
Objective quality is the kind in which a person sees the best fit for another person. This type of quality typically pertains to professional interactions, such as physicians treating a patient. Objective eminence is at least partially based on the target person (e.g., patient), but it ultimately rests in the evaluator’s hands. A physician’s contribution to patient care is vital for the quality of the service he renders but must also concord with patients’ subjective perception.
Subjective quality is patient-dependent and factors in understanding the care, expectation, and needs. In addition to entertaining patients’ desired outcomes, it also ensures their engagement and compliance towards even better care and healthier life in the future. We also need to keep in mind that subjective quality without objectivity of the treating doctor can be counterproductive as it potentially disregards the professional component of such quality. Therefore, the Balance of objective and subjective quality is essential in everything, more so in healthcare. But then again, we must solely apply that to individual scenarios such as personal doctor-patient interaction.
Recently we can’t avoid hearing about quality care and value-based medical service. Not because; what makes the latter different is its economic origin and corporate mission as a quality measure server. Although some evidence may back that, nonetheless, such evidence is Executive-driven quality standards, which not only are fictitious, but most of all are the biggest disruptors of the objective and subjective quality balance.
Profit-Driven Quality is not the same as Real Quality.
The new value-based reimbursement is economic quality, and any state’s economy, if not all today, is very much influenced by corporations and corporatism. For instance, today’s health insurance industry (along with pharmaceuticals) is the Sole price setter of the entire healthcare reimbursement and a significant player in setting quality medical care standards. And since the third-party payers (insurance industry) are generally for-profit, it utters them within a considerable interest conflict. Then one should wonder what kind of quality would be if corporations authorize the quality of care. Imagine how much profit an insurance industry can make by merely manipulating physicians’ clinical judgment. Yes- that is what is precisely happening today. Then how can we decide which country has the number one healthcare?
Because Medicine is the Science of Relativity but does everyone see the Same Way?
According to economists, healthcare quality is about the issues relevant to efficiency, effectiveness, value, and behavior in the production and consumption of healthcare resources. However, it is crucial to determine how to improve health outcomes and lifestyle patterns through interactions between individuals, healthcare providers, and clinical settings. Economist vision of quality healthcare is around healthcare systems operations and general behaviors such as smoking, diabetes, and obesity. In reality, it emphasizes government intervention, intractable unpredictability, asymmetric information, blocks to admission, externality, and the occurrence of a third-party agent. Health economists, thus, are merely about evaluating costs, charges, and expenditures. What is Uncertain for the economist is intrinsic to health itself, the kind of knowledge gap between a physician and a patient, also called asymmetric information.
From a Politician's perspective, healthcare is another mindset where the whole objective is to gain the populace’s votes, where such gain is not necessarily tactic oriented. Ins