To many patients, a poor outcome is not the result of the disease or their own behavior but, rather, of errors by the physician, HMO, or hospital. We know how difficult it is to define standard of care, yet we urge lawmakers and judges to define appropriate care for HMOs. Lawyers, courts, and legislators cannot define healthcare quality. It must be defined within the industry with use of outcome objectives and benchmarks. If we let quality be defined by laws, we will have a rigid set of restrictions that will impact our lives as much as laws impact the lives of HMO executives.
Physicians know that quality is enigmatic.
We have been struggling with the definition of quality in healthcare for years and have finally concluded that it is about outcomes. Now we are trying to decide which outcomes are important. None of the healthcare legislation has addressed outcomes. A case can be made that the threat of legislation helps clean up abuses. As I alluded to earlier, we have seen this happen with HMOs' control over access management.