Is There Any Ideal of 'High Quality Care' Opposing 'Low Quality Care'? A Deconstructionist Reading

Health Care Analysis 14 (2):123-132 (2006)
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The expressions ‘high quality care’ and ‘low quality care’ are cognitive and linguistic artefacts that help to structure people’s lives and thinking; for example, moves are now afoot internationally to pay bonuses to health professionals for delivering high quality care. United States programmes, most conspicuously, are assuming that high quality care can be validly distinguished from low quality care, and incentivised through bonuses. This distinction is always at least implicit, for high quality care has no meaning without low quality care. Through a ‘deconstructionist reading,’ this article discusses limitations of categorising the quality of care as either high or low. The limitations of this ‘binary opposition’ can include a lack of defining attributes; vagueness and fuzziness at the ‘boundaries’ between high quality care and low quality care; concealment of quality as a continuum; and use of the binary opposition to effect social order and control. Health policy implications of our analysis are discussed. Drawing upon the general medical services contract in the United Kingdom, we suggest an approach to overcoming the oversimplification and imprecision that categorisation tends to produce



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Philosophical Investigations.Ludwig Josef Johann Wittgenstein - 1953 - New York, NY, USA: Wiley-Blackwell.
Principles of categorization.Eleanor Rosch - 1988 - In Allan Collins & Edward E. Smith (eds.), Readings in Cognitive Science, a Perspective From Psychology and Artificial Intelligence. Morgan Kaufmann Publishers. pp. 312-22.
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Why the need to reduce medical errors is not obvious.Stephen Buetow - 2005 - Journal of Evaluation in Clinical Practice 11 (1):53-57.

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