The obligation to provide high quality health care has long been a fundamental tenet of ethical codes of physicians.  The right to appropriate healthcare is guaranteed in a national health insurance law.¹ Physicians continuously work to improve their professional ability and maintain and increase their knowledge and skills, thus improving the care offered to their patients. According to the WMA Declaration on Quality Improvement in Health Care, physicians and health care institutions have a responsibility to fight for continuous quality improvement of services.²

Defining quality in healthcare is not straightforward. There are many definitions of quality, used both in relation to healthcare and health systems. The World Health Organisation (WHO) suggests that quality of a health system can be defined by six dimensions: ³
 

• “Effective, delivering health care that is adherent to an evidence base and results in improved health outcomes for individuals and communities, based on need;
• Efficient, delivering health care in a manner which maximizes resource use and avoids waste;
• Accessible, delivering health care that is timely, geographically reasonable, and provided in a setting where skills and resources are appropriate to medical need;
• Acceptable/patient-centered, delivering health care which takes into account the preferences and aspirations of individual service users and the cultures of their communities;
• Equitable, delivering health care which does not vary in quality because of personal characteristics such as gender, race, ethnicity, geographical location, or socioeconomic status;
• Safe, delivering health care which minimizes risks and harm to service users.”

¹ National Health Insurance Act, 1994.

² World Medical Association, “WMA Declaration on Guidelines for Continuous Quality Improvement in Health Care”. Adopted by the 49th World Medical Assembly, Hamburg, Germany, November 1997and amended by the 60th WMA General Assembly, New Delhi, India, October 2009.

³ World Health Organization, Quality of care: a process for making strategic choices in health systems, 2006: 9-10. http://www.who.int/management/quality/assurance/QualityCare_B.Def.pdf [Accessed on April 2011].