Tuesday, October 23, 2012
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.