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David B. Nash, MD, MBA

JAMA. 1992;268(7):917-918.

	Since this article does not have an abstract, we have provided the first 150 words of the full text PDF and any section headings.

Imagine, for a moment, a private corporation that affects the lives of 32.4 million US citizens and one with yearly expenditures in excess of $113 billion. Yet, the corporation spends less than 0.3% of this figure on a program to ensure the quality of the "product" it delivers.¹ Now, senior officers in this fictitious corporation are proposing sweeping changes that will radically alter the methods for improving the quality of its products; but their proposal lacks a detailed business plan, budget, and convincing evidence of success in a test phase.

See also p 900.

While some observers may object to my private-sector analogy, I believe the article by Jencks and Wilensky (in this issue of THE JOURNAL²) describes just such a scenario for the Medicare program. Because this article proposes a plan based on a fundamental shift in thinking, I will first attempt to summarize its main points, . . . [Full Text PDF of this Article]

Author Affiliations
From Thomas Jefferson University, Philadelphia, Pa.

Footnotes
The opinions presented here are solely those of the author and do not represent official policy of the American Medical Review Research Center in Washington, DC, where Dr Nash is the current chairperson of the Board of Directors.

Reprint requests to Thomas Jefferson University, 1015 Walnut St, 621 Curtis, Philadelphia, PA 19107-5099 (Dr Nash).

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