Misuse includes injuries caused by physicians, adverse drug reactions in inpatients and outpatients, and lower quality of care for some minority groups and the uninsured. Measuring quality is a difficult prospect. Each health intervention requires a specific way to measure appropriate outcomes. Participants view outcome measures in different ways. For example, physicians and patients may have opposing expectations of the outcome of an examination.
Several agencies are concerned with the quality of health care delivery.
These include the National Committee for Quality Assurance, the Health Care Financing Administration, and the Joint Commission on Accreditation of Healthcare Organizations. These organizations may not all have the same standards of evaluating programs and services. In order for the quality of health services to truly improve, it will be necessary to establish a culture of quality that is internal in organizations, not one that is imposed by an outside body. Chin, Arthur E., et al. New England Journal of Medicine February 18, 1999.