Exploring the relationship between costs and quality in Danish hospital department. 1 . The association between cost and quality differs depending on how which quality is . containment and health improvement are compatible goals. President Obama is the only sitting president of the United States in modern in health care costs has declined sharply, and health care quality is improving . Association between availability of health service prices and. 7} that the route of cost-containment does not automatically propel one down the slippery slope of poor quality health care. The American Medical Peer Review Association's members, in a three-pronged approach, monitor the.
The president adopted a dual mandate for the ACA: In any case, it is difficult to argue with the results: An estimated 20 million more people are insured because of the law, the increase in health care costs has declined sharply, and health care quality is improving following its enactment. The Special Communication 1 by the president breaks some new ground; for example, by renewing a call for a public option on the exchanges created by the ACA.
Mostly, though, the report is a compendium of the numerous positive outcomes related to the law to date and how the worst concerns from creating massive job loss to substantial access problems have proven almost entirely untrue. However, robust evidence demonstrating the actual health benefits of the coverage expansions is more tenuous than suggested, 23 and the article does not revisit medical malpractice reform focused on safe harbors for evidence-based care.
First, perhaps the most significant surprise since is the substantial deceleration in health care costs.
Cost Containment and Quality Improvement Prioritized by States
The conventional wisdom at the time the ACA was enacted was that despite its ostensible dual mandate, the act largely addressed the coverage problem while doing almost nothing to address cost trends. That perspective was flawed and frustrating at the time, but even the most optimistic forecasts were conservative relative to what has since occurred.
Imagine, for example, if anyone had been bold enough to predict in that Medicare spending per beneficiary would decline on an inflation-adjusted basis through Yet, as the president points out, that is precisely what has happened, and recent data suggest that the slowdown in Medicare expenditures has continued.
For employer-sponsored insurance, the evidence points strongly to the economic downturn as the primary impetus. Ongoing conversations can lead to agreements on data-sharing standards, common claims processes, and payment incentives to providers who deliver high-value care. Regulating Providers and Insurers—States can use their influence as regulators to require insurers and providers to share data.
Such information can then be made public and used as a tool for patients or shared only with providers and purchasers. When providers see how they compare with similar providers, they often take steps toward quality improvement. The hurdle for states is that they do not have the authority to compel self-insured employers or Medicare to share information. Leveraging State Purchasing Power—States can require data sharing, compliance with data standards, and price and cost transparency through contracts in the Medicaid, SCHIP, and state employee health benefit plans.
The type of data collected by states must reflect their plans for data use.
The Association Between Health Care Quality and Cost A Systematic Review
Several states are leading the way in developing all-payer claims databases. Such databases are typically used for billing purposes so they are most useful for assessing costs, but they may also be used for making some quality and value determinations. States engaged in chronic care collaboratives or other practice improvement programs have developed patient registries to collect additional information about patient outcomes, such as blood pressure readings and blood sugar levels.
States seeking to use data for health information exchanges will need additional data such as laboratory values, physician notes, and test results, although such data e. Much of that information is still housed in file cabinets and not generally available by electronic means. Health Information Technology and Exchange There is broad agreement that electronic health information technology and communications can improve quality and save costs in the health care system.
When asked about their top state eHealth priorities, 25 of 42 responding states listed adoption of a health information exchange HIE.Access + Quality + Cost in Health Care
In addition, 12 states reported HIE policy development as a priority, 9 states listed development of electronic health records, and 7 states listed e-prescribing. In many cases, the current payment system does not offer financial incentives for coordination of post-discharge care. Policymakers recognize that efforts to prevent readmissions can have significant return on investment, saving the system money while fostering patient health.
The Association Between Health Care Quality and Cost A Systematic Review
Several of the initiatives align with recent state efforts, including the support of chronic care management programs, investment in health information technology, coordinated and integrated care, required transparency in cost and quality information, and promotion of patient safety. The significant variation in health care delivery models both between and within states will make it critical for federal policymakers to take advantage of the on-the-ground expertise of state governments.
The Commonwealth Fund, August To Err Is Human: National Academy Press, First, level of analysis is important because area-level studies may yield different results than provider- or patient-level studies 4.
Second, there are many ways to measure quality, each of which may have different associations with cost For example, a structural measure of quality, such as nurse staffing per patient, will probably have different cost implications than higher performance on an outcome measure, such as patient functional status.
Fourth, studies may use different statistical methods, particularly in adjusting for the effects of health status on quality and costs. To document the association between health care cost and quality and identify sources of heterogeneity between studies, we conducted a systematic review of evidence from published literature that assesses the association between health care costs and quality.
Methods Data Sources and Searches We searched published literature for studies that examined the association between quality and cost or spending measures. Keywords and medical subject headings included health care costs, health spending, and quality of health care, among others. We also examined the bibliographies of selected studies for other potentially relevant publications and considered studies found by ad hoc searches and consultations with outside experts.
Study Selection We included studies that empirically tested the direct association between a health care quality measure and a cost or spending measure; were published between 1 January and 10 June ; and focused on health care delivery at the patient, provider, or area level in the United States.
We chose these criteria to exclude studies focused on the cost—benefit or cost-effectiveness of specific drugs, devices, or medical treatments as opposed to the cost and quality of care in different delivery settings and to ensure that the results would be generalizable to other U. One reviewer reviewed titles and abstracts identified in the initial search for studies potentially meeting inclusion criteria.
Two reviewers subsequently reviewed the full text of these studies to make final determinations of study eligibility.
Cost Containment and Quality Improvement Prioritized by States | State Coverage Initiatives
Data Extraction Two reviewers independently abstracted relevant data from the included studies using a standardized form developed for this review. All discrepancies between reviewers were resolved by consensus.
Variables abstracted included unit of analysis, study population, cost measure, quality measure, control for confounders for example, age, sex, and health statusassociation between cost and quality measures, and statistical methods used. Data Synthesis and Analysis The main study outcomes of interest were the direction, magnitude, and statistical significance of the reported association between quality and costs.
Some studies compared the association between costs and quality using several types of measures. Therefore, the number of comparisons defined as a test of the association between cost measures of a single type and quality measures of a single type exceeded the number of studies.