Monday, September 30, 2013

Budget Constraints

(At the top where we belong.  
Photo Credit: Marie Castelli via

Every Sunday when we were little, my father gave my brother and me two coins each.  We were supposed to put one in the offering box at Sunday School and keep the other as allowance, which we could then pool together to buy snacks while we waited for the adults to be done with church.  Yet much to Peter’s chagrin, I’d often get caught up in Christianly love and happily give both of my coins to Jesus — which meant that not only could he not eat my chips, but I had to dip into his share. 

Much like my brother and me, you, insurance companies, and our government all have limited resources and competing demands.  One of us may even run out of cash on Oct. 17th.  Our constraints make the study of healthcare quality a health policy priority.  Since we can’t spend money on everything, we need to make sure that we are only spending our limited funds on quality items, like Jesus, seaweed chips*, and good healthcare. 

How does one measure healthcare quality?  In the classic quality paradigm, one can measure factors related to structure (e.g. staffing structure), process (e.g. physician hand washing), and outcome (e.g. patient mortality).  Things get thorny and fun when you start debating which which measures better reflect quality.  Patient satisfaction, for example, seems like a pretty good indicator.  As a society, we probably want to spend resources on healthcare that makes patients satisfied.  But patient satisfaction is also complicated by other factors that need to be teased out, like how friendly a doctor is and how nice the hospital food is.  Sometimes, the sickest patients are the most satisfied.  A 2012 study by Dr. Joshua Fenton et al, for example, found that having high patient satisfaction was significantly associated with higher health spending, more hospital admissions, and higher mortality.  This doesn’t mean that the most satisfied patients get the worst care, or we should invest our ObamaCare Bucks on stocking hospitals with duck fat fries (we so should).  It certainly doesn’t mean that patient satisfaction is bogus.  Instead, the study reflects the complexity of the issue and demonstrates how all that health policy wrangling over performance measures in the news are worthy debates.  Quality measures are a lot sexier than you realize.  They involves your money and your healthcare. Deciding the measures and how to hold providers accountable aren’t easy matters—that’s why there’s ruckus.  But it’s necessary ruckus, ‘cause we don’t have racks on racks on racks. 

*If you asked 9-year-old-me what I missed most about Taiwan, I would have said potato chips and hot dogs.  They just taste better.

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