Unbiased Analysis of Today's Healthcare Issues

Why shopping for health insurance is hard

The premise is simple.  Create markets, let consumers choose the products that fit them best, and the competition will lead to higher quality and lower prices.  That is the premise behind the Affordable Care Act’s health insurance exchanges.  A necessary condition for this to work, however, is that patients have visibility into the quality and […]

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Physician use of “Choosing Wisely”

Choosing Wisely aims to identify low value services and advise physicians to avoid or at least be more conservative in the use of these services.  The ability to implement these changes, however, depends on physician awareness of these initiatives.  A paper by Colla and Mainor (2017) examines trends in awareness of the Choosing Wisely initiative: […]

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Measuring hospital quality requires understanding what a hospital is

Many programs–such as Medicare’s Hospital Value-Based Purchasing (HVBP) program–aim to reward hospitals with high quality through higher reimbursement and penalize hospitals with low quality through lower reimbursement.  Will this approach be successful? A commentary by McMahon and Howell (2017) says that hospitals are not really unified entities but rather a collection of workshops. Thus, the […]

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Does patient demand respond to physician quality?

The answer to this question must be ‘yes’.  Everyone wants to see a good doctor compared to a bad doctor.  However, what defines a “good” doctor?  Patients perception of what makes a doctor good (e.g., bedside manner, clinic amenities) may not correspond to what technocrats or policmakers think (e.g., process of care measures).  Even if […]

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The cost of quality measurement

An interesting editorial in JAMA by Schuster, Onorato and Meltzer (2017) makes the following point: So how should quality measures be prioritized? Many factors are currently considered, including a measure’s expected effect on patients and health care, potential for promoting improvement, scientific underpinnings, usability, and feasibility. But there is a major omission from this list: […]

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Identifying high quality providers in the presence of heterogeneous preferences

Why is it so difficult for health care payers to identify a “best” provider?  A paper by Gutacker and Street (2017) explains: There are two key elements that complicate assessment of how well public sector organisations are doing their job (Besley & Ghatak, 2003; Dixit, 2002). First, they lack a single overarching objective against which […]

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Can physician quality be captured by a single composite measure?

Value-based payment for providers is often predicated on being able to measure physician quality with a single composite measures.  For instance, Medicare’ s Value-Based Payment Modifier (Value Modifier) combines a variety of individual quality metrics across domains to create a single quality score.  Payment to physicians is adjusted based on a combination of physician quality […]

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Does more spending improve outcomes?

A number of studies have claimed that increased health expenditures may result in no better, or even worse outcomes.  For instance, a paper by Fisher et al. (2003) looking at patients with acute myocardial infarction, colorectal cancer, or hip fracture finds that “Quality of care in higher-spending regions was no better on most measures and […]

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Diagnostic Ability and Quality of Care

Quality of care often is seen as how physicians and other health care providers treat patients with a given disease.  Accurately diagnosing the disease a patient has, however, is in almost all cases a necessary condition to provide high-quality treatment.  Nevertheless, a physician’s ability to accurately diagnose a disease is rarely measured within exsting quality […]

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Measuring the quality of cancer care

How do you measure the quality of care patients with cancer receive?  How long they live?  Avoiding side effects?  Patient satisfaction? Process measures? Further, there are multiple types of cancer and different cancer have different recommended treatments and methods of providing care.  To further complicate the issue, new cancer treatments are being introduced in rapid succession; […]

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