Health Economics, Policy and Law


Two faces of patient safety and care quality: a Franco-American comparison

Laurent Degosa1 and Victor G. Rodwina2 c1

a1 Past President (2004–2010), Haute Autorité de Santé (HAS), Professor of Medicine, University of Paris 7, Denis Diderot, France

a2 Professor, Health Policy and Management, Wagner School of Public Service, New York University, USA


Patient safety, and more broadly the quality of care, is typically discussed with reference to the reduction of preventable adverse events within hospitals and adherence to practice guidelines on care processes. We call it the ‘care-centered approach’ and recognize that the United States is a leader in the field. Another face of patient safety and care quality may be defined as the ‘system-centered approach’. It focuses on access to a timely and effective continuum of health-care services – clinical prevention, primary care and appropriate referral to and receipt of specialty care. Although France's efforts to pursue a care-centered approach to patient safety are limited, its system-centered approach yields some benefits. Based on the evidence we have reviewed for access to primary care (hospital discharges for avoidable hospital conditions), mortality amenable to medical intervention and consumer satisfaction, in the United States and France, there appear to be good grounds for bolstering the system-centered approach in the United States.

(Online publication April 27 2011)


c1 Correspondence to: Professor Victor G. Rodwin, Puck Building 2nd Floor, 295 Lafayette Street, New York, NY 10012, USA. Email: