Abstract

When comparing health systems, should “responsiveness” be a key measure of quality? Some suggest it places too great an emphasis on an economic sense of quality and has ideological connotations. Does it suggest, for example, that higher quality is linked to competition and choice and so is inherently limited in public systems? One paper suggests that discussion of international healthcare systems is underpinned by a “managed care is best” view. The World Health Organization reinforces westernised notions of what determines efficient and effective healthcare systems and imposes them on other countries for whom this cultural view is not appropriate.

Assumptions about the nature of quality also translate to measures used to gauge it. A BMJ paper suggests that NHS performance tables are based on assumptions that organisations will be better than one another and that patients are “consumers” who want to rank providers and choose the best; they are not geared to improving practice but to informing consumer choice.

Quality can be seen in many ways. The following papers published between December 2001 and February 2002 reveal some tensions between values underlying perspectives on quality and illustrate some of the difficulties in harnessing diverse perspectives on quality into a coherent critique.