Adjusting the balance in health-care quality.

In an increasingly informed society there has been a growing interest by consumers in evaluating the quality-of-care provided by their practitioners. This task is complicated by an asymmetry in the technical knowledge required to assess health-care quality between consumers and health providers. Recently attempts have been made to incorporate patient views into the assessment of quality to try and address this asymmetry. A number of quality initiatives have been developed to help provide consumers with markers of practitioner competency including professional training programmes and examinations, quality standards and quality assurance activities. International trends include federal funding for quality improvement activities within practices, and greater use of information technology to provide error warning systems for practitioners, to monitor practice patterns, and to promote better communication of information between health services. It is important in developing these new initiatives that 'symmetrical' approaches which capture consumers' views on quality are employed.