Quality assurance programs serve different roles in healthcare settings. They ensure that health services are cost-effective, responsive to public needs, and of high quality so that the safety of patients is enhanced (Donabedian, 2002). I believe that patients value the safety of health services more than the cost or their response to public needs. Many patients evaluate the quality of health services based on the level of safety during treatment and the potential to improve wellbeing after treatment (Spath, 2009).
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Patient safety encompasses practices that prevent medical errors and that utilize medical knowledge to improve patients’ wellbeing (Donabedian, 2002). Many people value safety more than other benefits related to quality assurance because of the reduction of the risk of adverse events or outcomes during treatment and the recovery process. Avoidance of errors during evaluation, diagnosis, and treatment is critical to the improvement of patient safety (Spath, 2009).
I think that many patients are ready to embrace the high costs of health services if the risk of succumbing to medical errors is minimal. High-quality health care processes improve patient safety and as a result, lead to positive health outcomes. It is possible to have quality care and cost-effective programs in place by encouraging collaboration between the government and stakeholders in the private sector.
Fragmentation and high costs of health care are two main reasons why many health care facilities lack quality care and cost-effective programs. More collaboration would improve patient safety and the quality of health services. Working together with organizations such as Centers for Medicare & Medicaid Services (CMS) and the American Healthcare Association would lower the costs of health care and improve collaboration between the government and the health care sector. CMS has implemented several programs and initiatives that promote the delivery of quality medical care at low costs. Therefore, utilizing government programs and collaborating with government agencies is critical in ensuring that health care facilities have both quality assurance and cost-effective programs.
Utilization review (UR) is a provision in health care that protects patients from inappropriate medical care through the evaluation of patient care (Spector, 2004). Health care providers review patient care based on aspects such as necessity, quality of care, length of hospital stay, and quality of decisions. The main functions of UR include enhancement of medical judgment, improvement of patient care, and achievement of better treatment outcomes (Spector, 2004).
UR can be included under the practice of medicine because its outcomes can directly affect the health of patients (Kongstvedt, 2001). For example, if a health care provider makes the wrong decision, the health of the patient is compromised. Also, physicians are obligated to provide quality and safe care to the patient at all times. UR is a critical component of quality and safe patient care.
Therefore, UR is part of the practice of medicine. In that regard, it should be limited to those medical professionals licensed to practice medicine because they possess the knowledge and skills necessary to avoid the poor judgment that could lead to negative health outcomes (Kongstvedt, 2001).
I think that a qualified and licensed medical professional should head the utilization review program. A licensed professional possesses the knowledge and skills necessary to provide quality medical care to a recommended degree of skill and judgment. Also, licensed professionals have been tested and proven qualified to handle patients and make decisions that promote positive health outcomes. Finally, qualified professionals have sufficient medical experience to make the right judgments regarding patient care.
Donabedian, A. (2002). An introduction to quality assurance in health care. New York, NY: Oxford University Press.
Kongstvedt, P. R. (2001). The managed health care handbook. New York, NY: Jones & Bartlett Learning.
Spath, P. (2009). Introduction to healthcare quality management. New York, NY: Health Administration.
Spector, R. A. (2004). Utilization review and managed health care liability. Southern Medical Journal 97(3), 34-38.