Recent efforts to measure performance have established its feasibility and value. However, its full potential is currently limited by several problems. They include the probabilistic nature, rarity, and confounding of many health outcomes; the inadequacies of information systems; the multiplicity of measurers and measures; the complexity of health plans; and the availability of funding. Solutions are to rely more on process measures; to justify every measure with a formal, evidence-based rationale; to improve information systems; to supplement population-based measures with case-based measures; to develop a single, nationally standardized set of measures; and to provide nonpolitical, public funding for the design and administration of measures.
