Friday, January 11, 2013
Quality of Care
I spent most of my working years in teaching hospitals,
which were generally considered to offer the best care available. Early on, however, I began to suspect that it
was not always necessarily so and that when the day came that quality could be
measured, there would be some surprises.
More specifically, I came to believe that teaching hospitals offered the
best care to patients with rare and complicated conditions that interested the
faculty, but that for the run-of-the-mill cases that constituted the vast
majority it was not necessarily so.
Information is now coming in that confirms my suspicion.
The January 7 issue of the Omaha World Herald reported that Omaha-based,
six-hospital Alegent Creighton Health System had become “the first health care
system anywhere to earn full accreditation from the Society of Cardiovascular
Patient Care in heart failure treatment, chest pain center services and atrial
fibrillation treatment.”
According to the report, some 800 U.S. hospitals have been accredited
in at least one of the three categories of cardiovascular care but in no other
case had all of the hospitals in a multi-hospital system been accredited in all
of them.
So it seems that if you have chest pain and go to the
emergency room of Midlands Hospital in Papillion ,
Nebraska , one of the Alegent
Creighton hospitals, you may well get care that is as good as you would have
received at Mayo or Johns Hopkins.
Wednesday, January 09, 2013
Markets and Health Care
Although we are not yet ready as a people openly to accept
that market forces can have an important and productive role to play in health
care reform, we continue to tinker with the possibility.
The Money (i.e., business) section of the November 19 issue
of the Omaha World Herald carried an Associated Press article about companies
that are switching their health plans from defined benefit to defined
contribution. Traditionally, employers
have selected for their employees a health insurance plan offering specific
benefits and paid all or a predetermined portion of the cost. Under defined contribution, the employer
provides the employee with a certain amount of money, which the employee can
use to pay for a plan of his or her choosing.
In some cases, the employee must choose from a list of plans
created by the employer. In others, the
employee can pick a plan from the list offered by “exchanges;” i.e., lists of
plans offered by insurers and benefit companies.
The consequence is that insurance companies will have to
compete for individual patients rather than for corporate accounts. Those who favor this approach would argue
that patients spending their own money will be more discriminating in the
market than companies that may be more concerned with providing a benefit that
their staffs find attractive.
There may be something to that, but the real potential of
market forces will not be seen until they are applied to the health care
delivery system itself; i.e., when hospitals and other providers have to
compete for patients on the basis of cost, quality and patient
satisfaction. The market described in
the World Herald article doesn’t really do that, since it relates only to
health insurance, which in most cases continues to pay whatever provider the
patient chooses.
But it is a start.