(At the top where we belong. Photo Credit: Marie Castelli via Facebook.com) |
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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