Measuring Quality in Health Care
“The United States simply cannot afford to pay $256 billion in healthcare
costs. The economy cannot support it.” This statement was taken from a
report issued by the Office of the Inspector General in 1980. Fast forward
to the year 2012, and health care costs are expected to surpass the $2.6
trillion mark. As a nation, we are spending more than 10 times the amount
that, in 1980, was predicted to break the proverbial bank. In a trillion-dollar
industry that serves hundreds of millions of patients, it is not surprising that
complaints of poor quality are on the rise.
What is poor quality? Conversely, what is excellent quality? Is the successful
treatment or eradication of whatever ails us considered quality? When you
stop to think about how to define quality, one realizes that there are dozens
of interrelated variables that shape our definition. Some of those variables
might include such factors as competence of staff, attention to needs,
measured outcome versus expectancy, courtesy, wait time, and so on. Some
of us might not mind waiting 4–6 hours for care in an emergency room,
while others would be highly dissatisfied. Put quite simply, quality is very
subjective. Consumers, providers, licensing boards, insurance companies,
and regulators all have varying definitions of quality.
While we might not all be able to agree on a mutually inclusive definition,
the demand for increased quality is coming at a time when cutting costs is
tantamount to sustainability. Consumers are demanding more for their
money. Providers are facing increased financial pressures trying to deliver
quality care to patients with insurance and without; unfortunately, the latter
is becoming more common. Licensing boards, insurance companies, and
federal regulators are increasing their audits and, in some cases, seeking to
increase their influence in an attempt to raise overall quality. Supporters of
increased oversight state that the health care community is
underperforming, and the only way to create quality is to enforce it. Critics
argue that too much oversight will curb creativity and that it forces
providers into a cookie- cutter approach to an otherwise diversified delivery
system.
At this point in time, arguing against increased oversight seems to be a moot
point. With the passing of the Affordable Care Act in 2010 (covered later in
this course), the U.S. Government has taken proactive steps in decreasing
financial reimbursement for providers who experience continued quality
issues. To err is human; however, to err in health care will now cost you.
How, then, do health care leaders balance an increased regulatory
environment with a rapidly changing clientele?
In this module, you will learn about the various models of quality
measurement within the field of health care and in what setting they would
be most effective.
References
Khan, F., & Khan, H. (2004). Quality management in the healthcare industry.
Decision (0304-0941), 31(2), 136- 167.
U.S. Office of the Inspector General. (1980). Semiannual report April 1, 1980 –
September, 30, 1980. Retrieved from
http://www.oig.dol.gov/public/semiannuals/04.pdf
