Must we choose between quality and cost containment?

Accepted for publication 10 September 1996 Introduction For the past few years, the United States has been engaged in a public policy debate about how to reform the healthcare system to assure access to care while cost containment. Underlying the deliberations is a concern that quality and cost containment are a trade off that is, that efforts to contain costs inevitably result in lower quality of care. This concern may explain, in part, why the effort to pass reform legislation two years ago was not successful. However, quality health care was neither defined nor debated; the concepts and goals of cost containment were neither explored nor explained; and the relation between the two was never discussed. Therefore, the possibility that there is no direct relation or even an inverse relation between quality and cost containment was never raised. Without any public consensus about what is meant by either quality or cost containment, it is difficult to evaluate their relation to each other fairly. The relation between cost containment and quality is an issue of universal interest. In this