The rise and fall of HMOs: an American health care revolution

Avedis Donabedian, who created the conceptual framework for quality assessments of health services, was interviewed shortly before his death in November 1999. He described the health care problems that he had encountered during his battle with cancer that lasted nearly three decades. Jan Gregoire Coombs quotes Donabedian in his last interview on page 277 of her book as follows: I have tried to choose doctors who worked together reasonably well but there are areas where no one takes responsibility, where planning is weak, when I am left on my own (...) HMOs today are good at measuring costs but pay little attention to measuring effects. The failure to look at outcomes undercuts all the reasons that so many of us were interested in the prepaid group practice... These few words of Donabedian summarize the message in the book The Rise and Fall of HMOs: an American Health Care Revolution.