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Quality in consumer-driven health systems.

In the global quest for improved 'quality' in health care, the purely clinical quality of health care should not be confused with the quality of the health care experience. Although the former is central to the latter, it is the latter that determines the overall quality of a health system. Americans have long had trouble with this crucial distinction. A survey of several distinct dimensions of the quality of the entire health care experience, for example, can help to explain why the technically sophisticated, expensive and often very luxurious American health system tends to earn relatively low scores in cross-national surveys in which respondents are asked to rate the overall quality of their health system. Many useful insights can undoubtedly be had from the system's myriad experiments with continuous improvements in the clinical quality of health care (just as Americans, however, could learn from similar experiments abroad). On the other hand, the bewildering and ethically dubious financial and managerial systems that Americans have put in place to foster continuous quality improvement in their health care may be self-defeating in the end. Policy analysts and policy makers in other countries may learn from the American experience to spare their citizens the agony.