Quality can be evaluated based on structure, process, and outcomes (Donabedian 1980). Structural quality evaluates health system characteristics, process quality assesses interactions between clinicians and patients, and outcomes offer evidence about changes in patients’ health status.
An example of structural quality problem is the Medicare program, which is blamed to be "reactive, rather than proactive". It focuses mainly on treating patients when sick with little or no emphasis on prevention and coordination. I think poor quality of care such as too much care, too little care, wrong care are mainly because of structural problems.
Process quality are relatively individual, due to different physicians. Outcome quality is closely related with physicians' professional knowledge and technology.
We can see that among these 3 levels of quality, structural quality is most difficult to change, but a better structure will definitely bring us more benefits.
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