Future policy directions for quality assurance: lessons from the Health Accounting experience.

More than 25 years ago I proposed a philosophic approach for the ongoing, systematic management of quality assurance in the U.S. health care system. Health Accounting, based on the premise that successful quality assurance must evolve into a professional discipline that integrates the health and the management sciences, called for an analysis of the benefits and "disbenefits" of health care services as rigorous as that used by business and industry to analyze fiscal profits and losses. In this paper, I review the origins and development of Health Accounting, assess what we have learned from our experience of the past 25 years, and discuss the implications of this experience for promoting the growth of quality assurance in the United States.