Much of the healthcare debate is centered on cost – the cost of: direct patient care, insuring millions of uninsured people, defensive medicine to avert malpractice lawsuits and administrative costs that eat up a large chunk of every healthcare dollar. How can we spend more than $700 billion each year on medical care that fails to improve patients’ health and often harms them? There is no easy fix to these problems, of course. But there is the best place to look: focus on quality. This is a book about debunking healthcare myths through the lens of quality. Poor healthcare quality derives from uncertainty in clinical decision-making, from persistent unexplained variation in physician practice patterns, from still-inadequate accountability for quality and patient safety, from payment for piecework and from medical training curriculum that is decades behind the curve. Reclaiming quality by addressing each of these deficiencies will transform the economics of our healthcare system. This is not a utopian critique. It is based on a quality revolution that is already underway and is gradually transforming the way medical care is delivered in the US. This is a pivotal moment in American healthcare delivery, marked by tremendous innovation aimed at “busting” our counterproductive myths: improving physician decision-making, building a better research base to compare the effectiveness of different treatments for the same medical condition, devising accountability mechanisms that work, piloting second-generation pay-for-performance models, paying greater attention to quality improvement in medical training curriculum and expanding access to quality care in non-traditional venues. Even the reader who thinks he or she knows all about some of the topics in this book will appreciate the manner in which Demand Better! integrates these topics into a cohesive appraisal of core problems and cutting-edge solutions that are of the greatest interest to them.

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