Building Quality Improvement Into Health Coverage Expansion Proposals

The purpose of this paper is to identify and explain how proposals to expand health insurance coverage can build-in features to promote and facilitate health care quality improvement. Of course, there is a strong association among health insurance coverage, better health care, and improved health outcomes. Thus, we would expect that almost all coverage expansions would improve quality of care for newly insured individuals. But the favorable impact of coverage expansion on quality of care can be substantially augmented if proposals to extend health coverage to the uninsured build in various design features specifically targeted to improving quality. These design features might be incorporated into a wide variety of health reform plans, regardless of the mix of purchasing responsibility between single and multiple payers or the relative roles for the public and private sectors. Some reform plans may be more conducive to quality improvement than others, but all could benefit from building quality-promoting requirements and incentives into their core designs.