What Does Quality Healthcare Mean?
Hospital quality measures are playing an increasingly important role in the reform of the healthcare system. The challenge is to find appropriate measures that reflect differences among hospitals, says Joseph Doyle, Erwin H. Schell Associate Professor of Management, Applied Economics, MIT Sloan School of Management. Doyle discussed “the quality of hospital quality measurement” in a presentation at Queen’s School of Business arranged by The Monieson Centre for Business Research in Healthcare. He shares his key points in this conversation with Scott Carson, Director of The Monieson Centre.
0:55 There is wide consensus that the healthcare payment system needs to reward quality of care rather than patient turnover. In the U.S., says Doyle, Americans do not trust their governments or the insurance industry to drive reform. “The last hope,” he says, “are hospitals and physicians.”
3:52 Doyle explains the differences between process quality measures (such as providing the proper treatment for specific conditions) and outcome quality measures (such as rates of mortality or readmission). These measures may not tell the whole story when comparing one hospital with another. Patient selection is the biggest wild card, says Doyle. Patients choose or are referred to hospitals based on the hospital's capabilities. The highest quality hospital in an area may treat the sickest patients or higher-income patients may be in better health and more likely to choose what is perceived to be a higher quality hospital. Such decisions may be reflected in hospital quality “report cards.”
5:58 Doyle and his colleagues studied the causal relationship between certain measures of quality and patient outcomes. Among other conclusions, they found higher-cost hospitals have significantly lower one-year mortality rates compared to lower-cost hospitals.
8:58 A key public policy question is, Can payment reforms reduce cost without affecting quality and patient outcomes?
10:22 Doyle on the Affordable Care Act, known as Obamacare. “What’s getting lost in the debate is that. . .the healthcare system is truly broken in the U.S. This is not a right-left issue.”