Quality and efficiency in a Swedish hospital and rural medical centre. Alternative methods of quality assurance.

Attitude studies of patients, their relatives, and sometimes even widows or widowers suggest that about 80 per cent of a small sample of Swedish in-patients are satisfied. However, the discontinuity of patient-staff relations in 69 per cent of out-patients is disturbing. There is a possibility that medical quality in the Swedish non-fee-for-service system is affected negatively by staff inactivity, which could explain slow diagnoses, long median durations of stay, and high cost. A tentative but comprehensive study indicates a theoretical efficiency increase in a large Swedish hospital of about 40, and a realistic increase of about 10 per cent. In the author's view, present attempts at cost reduction rarely achieve an efficiency increase, but they may reduce medical quality. The absence of quality assurance in parallel with cost reduction is criticized, and a WHO recommendation is proposed.