I think too many people in health care are paternalistic when it comes to providing information to patients. This group includes many, if not most, doctors and hospital administrators both locally and nationally.
There exists an inevitable movement to provide people information on doctors and hospitals. The information includes prices as well as quality measures. Having previously discussed prices on my blog, I will now focus on the effort to make quality information available to patients.
In the past, patients had to assume doctors and hospital were qualified based on third party reports. There was no direct to consumer information readily available to the average patient. There was no way to determine which doctor or hospital provided a higher quality of service.
It was assumed that if a doctor was board certified, he must have received the appropriate training in his specialty and passed an examination. Nowadays, to remain board certified, a physician must maintain continuing medical education credits through seminars or self-study courses and possibly, depending on the specialty, be required to pass the accreditation exam every few years. A failure would result in a loss of board certification, but not of the license to practice medicine.
Medicare would require hospitals to pay a third party to audit themselves every few years to assure the quality of care, and more importantly to the inspectors, and that the paperwork was up to date. Again, no information was available to patients other than whether the hospital passed or failed an inspection. A failure would result in the hospital no longer being allowed to bill for Medicare services. This would effectively shut a hospital down.
As patients are becoming much more sophisticated about their own health and the health care system in general, a demand has developed for more information. People want to be able to compare doctors and hospitals just like they compare car makes and models before making a decision on where to spend their health care dollars.
There are several inherent problems with trying to compare doctors or hospitals. A car make or model has a well defined service record and resale value. People don't. A patient might not get better compared to another one because of a multitude of reasons with the quality of the health care provided being merely one.
A doctor might have more elderly patients, more acutely ill or injured patients, or other demographic differences based on the location and type of practice, even within the same specialty. The socioeconomic condition of the patients might impact the compliance and ability to afford medications.
Comparing hospitals will have similar problems. Even after accounting for the difference in the size and location, considerable, confounding variables will exist making it difficult to fairly compare one hospital against another.
Another difficulty to be overcome will be the motivation of the reviewing organization. Unfortunately there is no Consumer Reports for health care. Health care quality cannot be tested in a controlled laboratory setting. Some groups do not divulge what information the assessment is derived from, but will provide that, for a nice fee, to the doctor or hospital so they can work on "improving" their rank with that specific group.
Who will be watching the watchmen is a question that should be asked of these self-appointed raters. There is tremendous opportunity to slant results for political or financial gain.
The upside will be that too much and conflicting information is better than the current situation of too little information. Most people will be able to sort out and compare information from different organizations to draw their own conclusions on the quality of different doctors and hospitals. Indeed they do so now based on a far lower quality and quantity of information, largely word of mouth.
Certainly some people will draw the wrong conclusions from the information given, but the American Way has always been for people to have the right to make poor choices. And a poor choice is less likely if it is also an informed choice.
