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Dr Howard  K  Rabinowitz  from Jefferson Medical College and other Medical Doctors in their article 'Innovative Approaches to Educating Medical Students for Practice in a Changing Health Care Environment' acknowledge that, the issues of quality health services have received public attention, with instances of inadequate care being reported in media and medical journals. There have been efforts to address the issue by encouraging employees by a group of the country's largest corporations to obtain healthcare where particular quality issues are addressed.

The article also addresses the healthcare costs that have been rising for decades. In part this has been caused by the dramatic advances in medical therapies and technology. With little likelihood that these forces will subside, the U.S. healthcare services are facing crises on the balance of cost and quality. The future health care system needs to improve quality of health care and control the cost of medical services.

There are social determinants that influence exposure to agencies that sustain or threaten health, affect the course and outcome of disease in individuals. In society the social factors also determine the decision making process by those affected and of those responsible for offering the health services. In a normal scenario the societal definition of heath and disease is relative and varies systematically among social groups. There is a noticeable range of political influence on healthcare services delivery. Government policies on taxes and budget allocation, governs the factors of cost and availability of quality services, especially to the resource poor (Lighter 2004).These policies guard the workers health rights.

The environment affecting health care may mean the patients physical or psychological environment or that of the practitioner (Lovallo 2004).  For instance, in a violent environment compliance with therapy and medical follow up is an up hill task to accomplish. Such an environment exposes patients to psychosocial risks that impact on health care seeking behaviors of people.  There is a crisis in balancing of ethical issues in professionalism. For instance on issues of life sustenance machines, life termination due to cost to be incurred, giving patient a painless death and pregnancy termination due to a mother's health.

Quality health care management is the efficient delivery of accessible uncompromised health care services by conducting and disseminating the results of applied health science to the society. Having understood quality health management, and the crises caused by costs and quality of services offered. There is need for all stakeholders that include policy makers, investors, professionals and the society at large to put measures that would encourage medical innovations that add onto quality of services offered and still control the cost of medical services for them to be accessible even by the resource poor in society.

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