Tuesday, October 23, 2012

 On Transparency and Choice 

Long-time friend and colleague Jeff Frommelt was kind enough to send me a copy of a September 22 Wall Street Journal article titled “How to Stop Hospitals from Killing Us.”  The author was one Marty Makary, a Johns Hopkins surgeon known for the development of a widely recognized surgical checklist. 

After roundly condemning the health care establishment for preventable errors that “kill enough people to fill four jumbo jets in a week,” Dr. Makary offers transparency as a solution.  He suggests that if hospital safety data were publicly available, patients would look at them and choose providers with the best records. 

I’m all in favor of transparency, but I’m not so confident that it would have the results that Dr. Makary foresees.  Publishing hospital performance information in an easily perusable form is not an easy thing to do and most people are not apt to spend a lot of time trying to understand it. 

A more effective approach, I think, would be one in which providers are organized into competing entities (Accountable Care Organizations?) and employers and insurance companies take responsibility for evaluating them based on quality, cost, and patient satisfaction.   Such organizations could afford to employ individuals with the time and expertise to study these matters in detail and reach informed judgments.  These judgments could then be made available to individuals for use in choosing an insurance company or provider.  

Of course, once the choice was made, the individual’s basic insurance coverage would be limited to a particular provider organization for the length of the contract.   Some people might not like that very much, but limitation of choice is an essential part of cost control and sooner or later they will have to get used to it.


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