No Toyotas in health care: why medical care has not evolved to meet patients' needs.

The incentives and structure of health care in the United States produce exactly what we should expect in the quality of care for chronic disease: highly variable patterns of care and widespread failure to implement evidence-based best practices. The persistent inability of providers to improve patterns of practice is due in part to the lack of a "business case for quality." Providers cannot anticipate that quality improvements will result in higher prices, increased volume, or decreased costs. However, signs of a business case for quality are emerging, fueled by cost pressures, the increased availability of data, informed consumers, and public- and private-sector purchaser initiatives.