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A Publication of WTVP

Most people would have an immediate answer to that question: of course it does. After all, you get what you pay for don't you? Maybe that's the part of the problem. Very few of us pay the majority of the cost for health care. So if I'm not scrutinizing quality, the entity that pays for the majority of my health care (employer or government) must be watching, right?

The reality is that high quality is assumed to be present. We assume every doctor, hospital, nursing home, and medication is high quality. We rely on recommendations. When choosing a restaurant, movie, or car, we often look for reviews with rating scales, repair rates, or rankings. Comparison shopping is a national pastime. So why doesn't it happen in health care?

Most of us access health care on an urgent basis. We don't plan to get sick and would rather not think of it as a possibility. . When we do get sick, we want to go somewhere close and quick. There isn't time to ask if the doctor is experienced with my condition and had good outcomes. We want a treatment right away or the most recently developed drug. There isn't time to wait for the condition to get better or try an older drug that may be as effective but not advertised.

Second is intimidation. Health care providers are extremely educated and respected for their knowledge and expertise. They're trained to be decisive and instill confidence. When we're sick, we aren't in a position to question a decision or ask for options. Most patients aren't comfortable asking health care providers for clarity or challenging a recommendation, and, frankly, only a few health care providers welcome either situation.

The third reason is the lack of performance measures, which is the main point of this discussion. Measurement is something medicine hasn't done effectively until recently. There's been a slow development process because medicine has always tried to focus on outcomes or perfection rather than processes. If the outcome or process wasn't perfect, it shouldn't be measured or reported until perfection was achieved.

OSF HealthCare has been an important contributor to this effort by participating with the Institute for Healthcare Improvement in addressing adverse drug events, mortality rates, crew resource management, and open access to physician offices. We measured our performance, identified areas for improvement, and collaborated with others to improve our performance. In addition, there are process measures on hospital performance in treating heart attacks, congestive heart failure, and community acquired pneumonia.

OSF HealthPlans reports its performance annually on Member Satisfaction and Clinical Effectiveness of Care Measures to the National Committee for Quality Assurance. These are standard measures using common definitions health plans from all over the country voluntarily report. It stands to reason that if it's being measured, it can be improved. Health insurance plans that report these measures consistently do better than plans that don't. Unfortunately, if you aren't in one of these health plans, it probably isn't being measured or improved.

If you aren't asking for this quality information, who is? Isn't it time to comparison shop for health care? IBI

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