What Is Quality Assurance in Health Care?

The term “quality assurance” means maintaining a high quality of health care by constantly measuring the effectiveness of the organizations that provide it. In the United States, two nonprofit groups dominate the performance-measurement field.

The National Committee for Quality Assurance accredits health plans, provider groups, and various medical businesses. The Joint Commission focuses on hospitals, laboratories, and many types of medical institutions. The Joint Commission and NCQA measure quality in different ways.

The Joint Commission Was Formed for Hospital Inspections

The Joint Commission on Accreditation of Healthcare Organizations began in 1951, when the major professional associations for hospitals and physicians joined to adopt a method for on-site hospital inspections. The system measured patient health after treatment – in short, effectiveness. In 1965, Congress made Joint Commission accreditation the de facto standard for hospitals that wanted to treat Medicare and Medicaid patients.

Seven years later, the U.S. government stepped in to validate and oversee the organization’s work. The marriage of private and public roles became part of the Joint Commission’s identity. The Joint Commission’s accreditation programs have expanded into a long list of different types of medical institutions, from psychiatric hospitals to drug treatment facilities to hospices to laboratories.

NCQA Began as a Means of Managed Care Oversight

Among Americans with health insurance, more than 70 percent are in NCQA-accredited plans. The NCQA began in 1979 as a managed care industry alternative to federal oversight. Independent since 1990, it accredits health insurance plans, physician groups, and other medical-service businesses through an evaluation system called the Healthcare Effectiveness Data and Information Set.

The NCQA also issues certifications and recognition programs for specialty programs, and it surveys customer satisfaction. NCQA measurements are widely used in media comparisons of health plans and institutions. Health plans, too, often use HEDIS to track how well their providers live up to recommended standards of care and cost-effectiveness.

A Unified System of Quality Measures

There are many other quality assurance systems, including those of individual states, the World Health Organization, and other countries. The federal Agency for Health Care Research and Quality, too, offers voluntary “Quality Indicators,” but the Affordable Health Care Act of 2011 suggested more extensive plans: standardizing quality measures across the health care field. The effort is part of the National Strategy for Quality Improvement in Health Care.

The Future of Quality Assurance

It remains to be seen how, and how quickly, the federal government standardizes quality assurance measurements. Evaluation systems are legion, but the two most broadly used in the United States, those of the NCQA and the Joint Commission, are firmly established in their overlapping areas of focus. Both enforce quality assurance by accreditation, which must be renewed every few years. Neither organization is going to disappear in the near future.