Chasing the Rabbit: Official Blog by Author Steven Spear

Gina Kolata’s article about sketchy medical imaging (”Good or Useless, Medical Scans Cost the Same“ NY Times March 1, 2009) is an eloquent specific example of why we have such high health care costs and such poor performance–compromised access, often terrible quality, and tremendous risk of otherwise avoidable harm.  The problem?  We pay providers based on the time and resources they consume providing care, instead of measuring the value they create in delivering care.  Without reliable measures of provider quality, patients and payers are handicapped when picking whom to trust their bodies and bullion, relying instead on self-referrals and on institutional reputations based on factors tangentially related to efficacy.  This makes no more sense than buying cars based on material and labor costs, regardless of scrap rates and idle time.As we contemplate “health care for all,” the federal government has a higher impact policy lever than throwing more money into an underperforming system.  Responsible for Medicare, Medicaid, Veterans Affairs, and the Department of Defense health systems, Uncle Sam is singularly able to demand that provider quality be measured and that patients be assigned based on those measures.  Doing so will reward individuals and institutions which couple affordability with quality and will punish those who charge a lot but deliver little.  With so much needless suffering in the current system and so much common wealth wasted, we could and should provide far better care to many more people than we currently do with less effort and at less cost.  

Related posts:

1. Provider Competition Key to Health Care Reform
2. Measuring Therapeutic Effectiveness and Cost–One Part of Better Care for All
3. Outcomes Measurement: The Linchpin of Healthcare Reform
4. Spear on Bloomberg: What’s health care reform missing? Quality!
5. United Health Group Settlement and Better Role for Managed Care Organizations