Improving Quality Outcomes in a Single-Payer System: Lessons Learned From the UK National Health Service Breast Screening Programme

The success of pay-for-performance initiatives in the United States as a function of improved quality of care is likely to be conditioned on the participation of all stakeholders. The ability of providers to develop quality improvement programs that receive sufficient resource support from the government represents a dynamic that has proved successful for the Breast Screening Programme, a part of the National Health Service, in the United Kingdom. A review of selected aspects of the program should serve as a template for consideration of how the deliberate coordination of clinical care can be improved under such circumstances.