Leadership by Example: Coordinating Government Roles in Improving Health Care Quality


The federal government operates six major health care programs that serve nearly 100 million Americans. These programs significantly influence how health care is provided by the private sector.

Leadership by Example explores how the federal government can leverage its unique position as regulator, purchaser, provider, and research sponsor to improve care -- not only in these six programs but also throughout the nation's health care system.

The book describes the federal programs and the populations they serve: Medicare (elderly), Medicaid (low income), SCHIP (children), VHA (veterans), TRICARE (military), and IHS (native Americans). It examines each program's quality enhancement processes -- that is, steps taken to assure and improve safety and quality of care.

The committee proposes a national quality enhancement strategy focused on performance measurement of clinical quality and patient perceptions of care. The discussion includes recommendations for developing and pilot-testing performance measures, creating an information infrastructure for comparing performance and disseminating results, and includes a proposed research agenda to support quality enhancement.