What We Think

Measurements, myths and misconceptions

By Richard Service, Editor

It took about 140 deaths to rouse the country to the dangers of exploding SUV tires. The estimated number of people who die every year from errors in hospitals is roughly 700 times greater.

How is it that we can process data so finely as to detect a pattern of tire failure among millions of autos, yet not be able to assess the quality of health care in a way that means something to consumers? And how is it that a relative handful of auto deaths—compared to 98,000 hospital deaths—can capture the public and the government's imagination? What keeps us from manning the barricades for better health care?

As it happens, some people are staging a quieter revolution. The hospitals described in our cover story, for instance, have abandoned the myth that quality care must never consider cost. They've learned how to conduct a sensible business, and it turns out that good business practice produces a cheaper and safer product. These hospitals spend more on staff and new technology, yet they spend less per patient. They have shorter lengths of stay, yet fewer complications. Does this sound like firms that are determined to maintain a competitive advantage? You bet. And it's why these hospitals have overall profit margins more than four times greater than those of their peers.

Elsewhere in this issue, we report the disconnect between what employers say is important to them when they select a health plan—access and quality of care head the list—and what health plans think is most important to employers—cost. This is not the first time surveys have revealed serious misperceptions of the customers' needs. When are health plans and hospitals going to wake up to the fact that quality products become market leaders? And when are employers and consumers going to learn enough about the system to demand the right information?

It's a little scary that the majority of employers are giving their health plans high marks for quality of care while at the same time admitting they don't get and don't use data on quality. Scarier still, most consumers are clueless about realities of health care delivery. A new study from the Center for Studying Health System Change concludes that only 30 percent of consumers can correctly identify four basic health plan features regarding provider choice and access to specialists. The Employee Benefit Research Institute found a similar level of confusion last fall, with three out of five managed care enrollees saying they've never been in a managed care plan.

These are the same people who are expected to become knowledgeable consumers of health care and revolutionize the system in the very near future. At this point, though, it looks as though consumers—not to mention providers and purchasers—are more likely to trip over the barricades than foment change.

 

Richard Service. Measurements, myths and misconceptions. Business and Health 2001;4:6.