Monday, November 05, 2007

Yet another plug I should have made.....

OK, so I'm still catching up. There's another shout-out that I keep meaning to make. The Partnership for Healthcare Excellence launched their website a couple of weeks ago. If you live in Massachusetts and haven't heard of them yet, you will soon.

Every Health Economics 101 class begins with a description of the basic tenets of competitive markets (many suppliers and demanders, homogeneity of products and services, full information, yada yada yada). The class then goes on to show how the health care delivery sector violates every tenet.

Health care markets deviate from the theoretical definition in a few ways. For example, consumers don't have enough incentive to worry about value-for-money (because insurance shields them from transaction prices), and they depend on their suppliers (ie, medical professionals) to tell them what services they need. Some of this deviation is structural -- the health care market is never going to operate like the auto or cereal industries because the stakes are too high and the services are too complex.

There is now a push for more tranparency in health care, which is edging the entire industry toward performance measurement and public reporting. The Massachusetts Health Quality Partners is one of the country's leading efforts in this area, the Massachusetts Quality and Cost Council is gearing up for more public reporting, and a bunch of states are already publishing reports on quality measures, hospital infection rates, costs, and medical errors (among them are Vermont, Pennsylvania, Florida, Missouri, Indiana, New Hampshire, and Massachusetts).

The real question, though, is whether consumers will make use of this information. Some believe that consumers will never act on such information, so it's a waste of time and effort. Others agree that consumers will never act on such information, but if their medical professionals will or their employers will, it's still worthwhile. Regardless, the hope is that public reporting will affect consumers in some way, whether directly or indirectly.

Employers can act as smart purchasers on behalf of patients to a certain extent, by locking in financial incentives to behave in certain ways and by demanding more from their health insurers or providers. The Group Insurance Commission tiers physicians and hospitals, for example, and structures financial incentives accordingly. Putting boundaries around what patients can demand will only get us so far, however.

What we'd all like to see is patients individually acting both as better consumers of their health care dollars AND better users of the health care system. Yet, it's hard for them to do this on their own -- our health care delivery system is too complex, and they've already become accustomed to playing a certain role in the physician-patient relationship. Actionable education is the key to bringing about this change, and that's where the Partnership for Healthcare Excellence comes in. Check out their site -- you might just learn something.....

3 comments:

Tom Drapeau said...

Micky, thanks, appreciate the heads up. I think patients and health insurers will use the information. I think a big challenge will be the lack of information about the continuity of care.

Micky Tripathi said...

Great points Tom, thanks. On continuity of care, that's where untethered patient portals built on top of community-based HIEs come in, which is MAeHC's mission.......but I'll leave that for another blog entry.....

CT Olson said...

Good blog Mickey. This is a topic that I have been railing about for years. Not only has the cost of care been increasing much faster than inflation but we continue to put up with a black box as far as the value proposition in health care. I won't go into the insurance thing, although I think we'd be better served by a simplified system augmented with private insurance ala France. Back to health care though, I don't know if you're aware of or blogged about the Committee to Reduce Infection Deaths, but I find they have a lot of valuable information as well. Full disclosure of infection rates should be a minimum standard for facilities. Some have even suggested a system like restaurants where the last inspection and results are posted on the front door.