Unbiased Analysis of Today's Healthcare Issues
Pay-for-performance (P4P) has long been tauted as a means to improve quality. However, since the Holmstrom and Milgrom (1991) paper on multitasking, it has been known that compensating individuals on one measured dimension can compel them to substitute effort away from unmeasured dimensions. For instance, if a mortgage broker is compensated only for the number…
If economists decided to re-write the Ten Commandments, “Thou shalt love Competition” may make the list. However, does competition always improve quality? Even in the case of health care? A paper by Scanlon et al. (2008) “…found no evidence of a strong and consistent relationship between HMO competition (measured either by the HHI or the…
P4P. Evidence-based medicine. Insurers and policymakers want to be sure that patient insurance premiums are being used towards high quality medical care. One example of quality evaluation in practice is the Apgar Score. In 1952, Dr. Virginia Apgar developed this metric to evaluate the health of newborns. Newborns receive a 0, 1, or 2 score on 5…
In the U.S., 2.9% of individuals who enter a hospital are actually harmed by the medical care they receive. Reducing these preventable iatrogenic injuries is one of the goals of any hospital administrator. Paul Levy of Running a Hospital lists 3 goals to achieve in the new year which will help reduce these adverse events.…
Many health plans have used patient health ratings as important metrics for quality improvement. The simplest way to evaluated the quality of a health plan is to ask all members to rate the plan from 1-10 and take the average score. However, this simple averaging gives health plans an incentive to improve quality for low…
Patients choose hospitals based on the quality of the medical care they receive and the hospital’s distance from their home. But what nonclinical criteria do patients value most? The Salud y Gestión blog reviews the findings of a study in The McKinsey Quarterly. The study found that patients rank the following as the most important…
Recently, the San Diego Union Tribune reported that the Sharp Grossmont Hospital in eastern San Diego county was cited for a number of preventable deaths. Reporter Cherl Clark found numerous problems, which included: “staff members restraining a highly medicated, 25-year-old man with schizophrenia in such a way that he was allowed to suffocate. In addition,…
The Washington Post reports that U.S. Health Care [is] Still Ill. This conclusion comes from a report from the Commonwealth Fund titled Results from the National Scorecard on U.S. Health System Performance, 2008. Even though the U.S. still spends more money on medical care than any other nation, performance on the Scorecard has not improved…
“When regulators or policy makers succeed in improving the quality of care provided by some doctors, do patients even notice and/or care?” This is the question which Kenneth L. Leonard attempts to answer. Davies and Ware (1988) do state that patient satisfaction is correlated with average quality levels. One problem with most studies is that…
A New Yorker article (“The Checklist“) recounts Peter Pronovost’s efforts to improve the delivery of medical care. One of his simplest ideas was to invent a 5 step checklist to reduce line infections: Doctors are supposed to (1) wash their hands with soap, (2) clean the patientâs skin with chlorhexidine antiseptic, (3) put sterile drapes…