Donabedian's Legacy: The Future of Health Care Quality Law and Policy

Abstract

Asked to imagine the next twenty-five years of quality-related health care law, the author decided to tackle a somewhat different question: Given the path that health care law and policy has taken in reaching its current form, what is its likely future trajectory? Parts I and II of this article trace the evolution of both health care quality law and quality-related legal scholarship. It was not until the 1970s and early 1980s that a few legal scholars, motivated in part by federal reform efforts directed at controlling costs, began to take a more comprehensive look at mechanisms for quality related oversight. By the 1980s, the focus on quality, as opposed to just competence, began to intensify as a result of a growing commitment to evidence-based medicine, a firmer analytic foundation for assessing quality, and rapidly accumulating documentation of deficiencies in care. The trend toward quality measurement that began to accelerate 25 years ago continues today, evolving in ways that help address concerns raised by legal scholars writing at an earlier stage of the evolution. Part III of this article discusses continuing challenges in quality-related regulation and considers how quality measurement could help support continued improvement of the health care system, including through more systematic tracking of the impacts of health system interventions.