Is quality affordable?

The question " Is quality affordable? " is loaded with dynamite! Can a person who lives on less than US $1 per day afford a high-quality cataract operation? If the answer is 'No', then do we offer that person poor or low-quality services? Do people living in poverty have a 'right' to high-quality eye or health care? If the answer is 'Yes', then at what price and who should pay? Should we ignore quality and focus on affordability? Or should we provide high-quality services in the hope that someone else will pay? These are difficult questions, which policy makers, managers, and clinicians must face and try to answer. What is quality? How do we define and measure quality? A simple analogy will highlight the complexity of this issue: if we have a meal, how do we judge its quality? We can measure how many calories, vitamins, etc. the meal contains, or we can decide how satisfied we are with the food, and we may also take the service into account. Our degree of hunger and the price we pay for the meal may influence our level of satisfaction. The American Medical Association defines the quality of care services as " the degree to which [these] services influence the probability of optimal patient outcomes. " 1 The World Health Organization offers a more comprehensive definition 2 and divides quality in four sections: Professional performance 1 (technical quality), including: evidence-based practice • clinical audit • development of guidelines • measures of outcome • use of resources 2 (efficiency) risk management 3 (risk of injury or illness associated with the service provided) Patient satisfaction 4 The different aspects of quality have been formulated into a set of six characteristics that any high-quality health programme should display. 3 As shown in the Box overleaf, such a programme should be: safe, effective, patient-centred, timely, efficient, and equitable. Quality can vary markedly between organisations. An ophthalmic centre in a high-income country will achieve different outcomes for patients when compared to a low-resource organisation in a low-income country. However, each organisation has a duty to maximise quality within its own resources. Quality is a 'whole system' concept: this means that every individual in the organisation, regardless of function or position, should be encouraged to find ways to improve quality. It is important that we define precisely what quality means to our team or organisation. This maintaining clean …