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Overview | Agenda | Workshops | Exhibitors | Sponsorship Opportunities
Health care quality is difficult to measure and means different things to different stakeholders. Economists Joseph Newhouse and Stuart Altman will explore why the health care industry seems to underperform and the impact of financial incentives in their keynote presentations at the Consortium's HealthMart 2003 conference on October 24th. Attorney Gloria Larson of Foley Hoag LLP, also an economist, will moderate this panel on: "Making the Business Case for Quality Improvement: the Economist's Perspective." Many people believe that health care quality falls short of expectations given the amount of spending, especially when compared to quality expectations in other industries, according to Professor Newhouse, of Harvard Medical School. "It's hard to imagine talking about a "Quality Chasm" in industries other than health care," he said, referring to the Institute of Medicine report of that name and subsequent articles. During his talk, Professor Newhouse will look at why the industry seems to underperform so badly. He and Professor Altman, of Brandeis University, also will examine the economics of reimbursement. "If reimbursement is used to reward quality to a greater degree, many issues are raised, including the question of how to measure quality," said Professor Newhouse. Ms. Larson said she will challenge Professors Altman and Newhouse to present practical solutions to improve the quality of health care in the United States. "In particular, I would like to have them elaborate on how we can align the interests of purchasers, providers and patients to work together toward increased health care quality. One approach would be to move from a system in which better quality health care is not financially rewarded to a system that provides clear and attainable financial incentives for improvement, she said. Health care providers would be given clear incentives to give better care, patients would be given incentives to participate in their own wellness by acting to prevent future illness and following recommended treatments when illness occurs, and purchasers would better understand and realize the long-term economic benefits of quality care. Professor Newhouse noted that it is difficult to formulate positive financial incentives. "They're fraught with problems, which is why we don't often see them." And Professor Altman said he is not sure how willingly the business community will pay for quality. "As we throw more money at the quality issue, employers may not be willing to pay, and there will be ramifications," he said. "I don't expect to see a careful cost-benefit approach to escalating costs, but a blunt attempt to reduce costs, which ultimately will have a negative effect on quality." Some people claim that quality is less expensive. A provider may not have to do a procedure or test over if it's done right the first time. However, depending on the method of reimbursement, e.g., if the physician gets paid the second time a test is performed, there may be no disincentive for duplicate tests. "The payment system is discouraging, encouraging or neutral on quality, depending on how one looks at it," said Professor Altman. "There is a disconnect between values and incentives. The provider, insurer, employer and patient are not necessarily on the same page in terms of paying for quality." He also noted that perceptions of quality differ. For the patient, a smiling nurse and extended time with the physician might be a positive experience, and thus considered quality care. "The end product of that positive experience may not have had much to do with whether a patient got better, but whether he feels better about the experience. It's not the technical definition of quality," said Professor Altman. He sees managed care as the impetus for the increased focus on quality of care. "People assumed they were getting high-quality health care during the '70s and '80s because they paid a lot and few had studied the issue closely. The advent of managed care in the '90s made people think about quality and question not only managed care, but all health care," he said. Professor Newhouse noted that academic literature on quality of care goes back to the 1970s, and, while it was not visible to the general public, it was available to analysts. Yet even with attention now riveted on health care quality, he said it is difficult to educate the consumer, especially given that the consumer wants information about a specific local market and about his own physician. "The evidence on how health care report cards are used by the general public has been discouraging in terms of patient decision-making," he said.
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