Health Care Quality Measurement

Pressure to reduce the growth of health care spending is at an all-time high as policymakers seek ways to reduce government spending and health care expenses strain household budgets. However, there is a concern that cuts to health care spending will reduce access to high-quality medical treatment.

On the other hand, some have argued that expensive health care is not only not better than less-expensive care, it can even be harmful. According to this argument, cutting back on wasteful, expensive care would both reduce health care spending and improve quality.

If you've spent more time researching which flat screen TV to purchase than which doctor or health plan to choose, you're not alone, according to the American Institute for Preventive Medicine (AIPA). Despite the fact that annual health care costs have nearly doubled in the past decade for the average U.S. family, consumers tend to shy away from negotiating with providers or asking if a costly test is truly necessary.

Responding to this trend, AIPA has named February Wise Health Care Consumer Month—a time to encourage consumers to take a more active and informed role in their health care decisions. According to AIPA, a “wise” health care consumer analyzes and evaluates sources of health information, then chooses their health care plans and providers thoughtfully.

As Nobel laureate Kenneth Arrow famously observed, health care doesn't behave like a normal market in which both buyers and sellers have the information they need to make a decision. In the health care market, sellers (physicians, hospitals, health plans) have the advantage because they usually know far more about the product (medical care) than buyers (patients) do. So consumers have played a limited role in the market.

However, there is one dimension of health care about which only consumers have accurate information: their own experiences with care. Only patients know whether their pain was adequately controlled in the hospital. Patients can observe and reliably report whether health care providers communicated clearly with them, whether they experienced long waiting times, or whether they were treated respectfully. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) family of surveys is designed to capture these and similar observations in a systematic way that facilitates reporting the results publicly to help other consumers make care decisions. The assumption is that reporting consumer experiences can shape the market by helping other consumers make more savvy decisions. In addition, consumer choices may influence providers and purchasers to improve the care they offer so that they can effectively compete in the market.

This Letter to the Editor appeared in The New York Times on March 22, 2012.

Theresa Brown's critique of patient experience surveys notes the value of multiple measures of patient care. We agree. Unfortunately, she also repeats two common misconceptions about the Hospital Consumer Assessments of Healthcare Providers and Systems survey, which we helped develop.

One is that there are necessarily tradeoffs between good patient experiences and good clinical care. The preponderance of the evidence (at least four recent studies) suggests the opposite: hospitals that perform better on the survey tend to do better on clinical measures, have fewer readmissions within 30 days and have lower risk-adjusted mortality.