External Forces and Their Impact On Health Care
Health care quality and safety are not solely dependent on the actions of individual providers and institutions. A host of external forces exert a profound influence on what happens within any single organization or the behavior of any individual provider. These external forces include accreditation bodies, regulators, legislatures, insurers, and many other entities. Sociopolitical forces, including the economy and public opinion, also play a role in how and how well health care is provided.
The predominant model for the delivery of health care in the United States and other parts of the world is fee-for-service. A new model gaining in popularity is known as pay-for-performance, or P4P. In the P4P model, providers are paid for how well they provide care, not how much care they provide. There are rewards for high quality, efficient and effective care and penalties for wastefulness and medical errors. Whether or not P4P can raise the standards of care and/or lower its cost is a matter of some disagreement.
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