As I wrote just a couple of days ago, health care doesn’t work well in a traditional market setting for a variety of reasons. One big reason is that consumers lack information about the quality of the care they receive. While I do believe that more transparency and public accountability are needed, I am not yet sold on the idea that people will start using quality data to comparison shop for their health care if it is just collected and made available. My skepticism arises from the fact that there are many other ways in which health care does not operate like other goods and services. Should we be interested in getting this quality information? Absolutely. Will it suddenly bring the market back in line? I doubt it.
An article in the Milwaukee Journal Sentinel examines the work being done in Wisconsin as part of the Robert Wood Johnson Foundation’s Aligning Forces for Quality initiative, which began in 2006 and aims to understand quality and improve it by collecting and reporting data at the local level. Right now, there are 15 demonstration sites across the country taking part in the effort, and the National Program Office for Aligning Forces is housed at George Washington University. In fact, the associate director, Marsha Regenstein, was my thesis adviser during my masters program there. So, if anything, my biases would lean in favor of what this project hopes to do.
Here’s what RWJF and others think that AF4Q (as it is known) can do:
- Help providers improve their own ability to delivery quality care
- Help providers measure and publicly report their performance
- Help patients and consumers understand their vital role in recognizing and demanding high-quality care
It all sounds quite good. My initial impression is that such an undertaking could certainly achieve the second goal. However, achieving the first goal probably has much more to do with incentives, and will depend heavily on how far patients go in demanding high-quality care (goal 3). That’s not as easy as it seems.
I worked in environmental health for a short time, where one of my duties was to conduct inspections of restaurants. You may have seen these scores posted on the wall of a place you frequent. In some cases you may live in an area where low scores are posted in the newspaper or shown on the local television news. You may have stopped going to a particular spot if it happened to get a low score. But what is low? 90? 80? 70? At what point do you, as the consumer, walk away and head elsewhere? Some states only use a letter grade system. That makes it even more confusing. Besides, have you ever stopped to look at the components that led to the particular score received? It is entirely possible for a restaurant with a slew of small (i.e., not likely to harm you) problems to score worse than a restaurant with one major (i.e., life-threatening) infraction. You won’t know that if you just read the score.
So, assessing quality in health care is not an easy task, but disseminating the data to the public in a way that they can understand, and–more importantly–that truly conveys all of the relevant information (e.g., is not oversimplified into a letter grade system) will require a monumental effort.