Tuesday, February 3, 2015

Slippery Subject – Health Care Quality

No one means all he says, and yet very few say all they mean, for words are slippery.

Henry Adams (1818-1918), The Education of Henry Adams

Congress will soon vote to repeal ObamaCare, President Obama will veto the repeal, and both will claim their position is based on quality.

Congress will define quality as individual freedom and choice of doctors and health plans. President Obama will define quality as affordable health care for all. Congress will say loss of quality comes from government control of peoples’ lives. The Obama administration will loss of quality comes from high costs. Congress will insist that people should be allowed to choose what health plans suit them best. obama will say only only health plans that comply with our mandates are best.

Obama supporters will maintain only health care experts know what is best.

Health care quality is a slippery subject, embedded irrevocably in the minds and philosophies of the beholders.

One side thinks health care quality is a subjective Art and depends on managing expectations and pleasing patients through individual services and lower costs by discarding bureaucratic impediments. Quality of health is not always measurable, and is often beyond hospital and physician control once patients leave their premises.

The other side believes health care quality is an objective Science and is best managed by use of data to better patient outcomes and control physicians’ economic behavior. Quality is always, in one way or another, measurable statistically.

One side says trust your individual instincts as to what is best for you and trust what you and your doctor and his or her organization decides is best for you. Quality is about trust in individual relationships. Quality is about trusting your doctor to do the right thing. Quality is private confidential matter, not a group effort.

The other side says trust your government and large organizations with population data indicating what works best on average for masses of patients. Quality is about the quantity of data that can be brought to bear. Quality is about the value of the services provided. Quality is about suppressing those services that do not better outcomes. Quality is about data will lower costs but better care.

To patients quality may be something entirely different. It about how the doctor and his/her staff make you feel, how they greet you, how they make you feel, how they explain things to you, how closely they listen to you, how they follow up to see if you were satisfied with your care, whether they meet your expectations.

Quality is slippery. It is a debatable trillion dollar question (“ Quality Is a Trillion Dollar Question” Washington Post, January 30, 2014; “Debate Heightens over Measuring Health-Care Quality; Puts Pressure on Hospitals and Doctors,” WSJ, January 30, 2014).

I close with this terse verse

Government may think it knoweth

What is best for most of us.

But the market often bestoweth,

What is good for the rest of us.

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