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What Is Accountability in Health Care?

What Is Accountability in Health Care?,Ezekiel J. Emanuel,Linda L. Emanuel

What Is Accountability in Health Care?   (Citations: 45)
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Accountability has become a major issue in health care. Accountability entails the procedures and processes by which one party justifies and takes responsibility for its activities. The concept of accountabilit y contains three essential components: 1) the loci of accountabilit y- health care consists of at least 11 different parties that can be held accountable or hold others accountable; 2) the domains of accountability—in health care, parties can be held accountable for as many as six activities: professional competence, legal and ethical conduct financial perfor­ mance, adequacy of access, public health promotion, and community benefit; and 3) the procedures of accountabil­ ity, including formal and informal procedures for evaluat­ ing compliance with domains and for disseminating the evaluation and responses by the accountable parties. Different models of accountabilit y stress different do­ mains, evaluative criteria, loci, and procedures. We charac­ terize and compare three dominant models of account­ ability: 1) the professional model, in which the individual physician and patient participate in shared decision mak­ ing and physicians are held accountable to professional colleagues and to patients; 2) the economic model, in which the market is brought to bear in health care and accountability is mediated through consumer choice of providers; and 3) the political model, in which physicians and patients interact as citizen-members within a commu­ nity and in which physicians are accountable to a govern­ ing board elected from the members of the community, such as the board of a managed care plan. We argue that no single model of accountabilit y is appropriate to health care. Instead, we advocate a strati­ fied model of accountabilit y in which the professional model guides the physician-patient relationship, the polit­ ical model operates within managed care plans and other integrated health delivery networks, and the economic and political models operate in the relations between managed care plans and other groups such as employers, government, and professional associations.
Published in 1996.
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