Blog | Monday, June 25, 2012

High health care costs does not equal quality

The new buzzword in Medicine these days is "value based purchasing." It's not a new concept. Everyone wants to get their money's worth, whether it is a new car, a meal at a fancy restaurant or the best medical care. Without clear information on quality, however, many patients assume that more expensive care is better care.

The Agency for Healthcare Research and Quality (AHRQ) has funded a study to look at this. A team of researchers studied how various presentations of cost and quality influenced the choices of patients. They found that many people perceived low cost clinicians to be substandard and avoided them. It didn't matter if they were paying out of pocket for care or if they had insurance that covered the service. They still associated higher cost with higher quality care.

When patients were given information in the form of easy to understand data about care quality they were more likely to make choices that didn't cost more. It mattered how the data was presented.

Americans spend more on their health care than citizens of 12 other developed nations, but the quality of that care (as measured in outcomes, accessibility, preventive care) lags far behind. It is difficult for a patient to know what "quality" care is. According to Peter Lee, the former chief executive of the Pacific Business Group on Health, "For most consumers, the fact that there is no connection between quality and cost is one of the dirty secrets of medicine."

Most people don't have the time or expertise to delve into finding out if their doctor, hospital or surgeon can deliver "value" for the cost. There are a number of websites that compare hospital outcomes for surgeries, infections and treatments but they are cumbersome and the data can be two or more years old. Essentially they are useless for the patient.

Until we can:
--define quality,
--provide transparent data that is easy to understand, and
--provide pricing and costs that are easy to understand,

we will never be able to bring the escalating cost of health care under control. Until that time, patients are flying blind and hoping that their high cost care delivers something in return that they can value.

This post originally appeared at Everything Health. Toni Brayer, FACP, is an ACP Internist editorial board member who blogs at EverythingHealth, designed to address the rapid changes in science, medicine, health and healing in the 21st Century.