Changing Expectations: Quality

This post is excerpted from the new paper by Jon Shreve, “Changing Expectations in Healthcare.”

Increasing access is not the only goal of real reform; improving overall quality and efficacy is also an important goal. Simply pumping more money–or people–into the present healthcare system does nothing to improve the underlying quality of care. Provider practices and patient demands that result in low-quality care are not only bad for the patients involved, they also force on all of us a kind of rationing driven by the inefficient use of resources.

A consensus, however, is forming around the expectation that evidence-based medicine is the key to improving the quality of care. Why?

  • Inconsistent care–unfounded variations in the approach that physicians may take when recommending care–leads to contradictory results and higher costs.
  • Conversely, the higher costs associated with more procedures and services do not automatically assure better quality. Examples abound where procedures are routinely performed by some physicians that, over the long term, reap no significant benefit to clinical outcomes.
  • Inappropriate care produces adverse outcomes. Overuse of procedures exposes patients to unnecessary risks for complications, increasing costs without enhancing benefits. Underuse–not providing medically beneficial services–costs less in the short term but much more in the long run, especially for chronic diseases. Misuse–like medical mistakes or complications–is detrimental to patients, providers, and payers.

Evidence-based medical guidelines are well established within the private sector today, and the vast majority of third-party payers use them to determine medical effectiveness. This same approach could guide every physician’s bedside practice.

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