You Deserve the Best Care – Problems With the Results Based Approach to Quality

By | May 22, 2012

How many people would see this doctor if they really had a choice?

As we have said before the results based approach to the measurement of the quality of medical care, while good has certain inherent problems. The first is the necessarily retrospective nature of the analysis, which is a problem in the United States where the government would like to tie payment to quality of care. This approach is used with greater success in Europe where physicians are for the most part government employees and payment is not an issue. In this country the retrospective results based approach has been applied to hospitals with some success (e.g. the closure and reorganization of Martin Luther King Medical Center). This approach could be applied to a single physician over the course of his career, by tracking the outcomes of all of his or her patients and then retrospectively comparing them to national averages, but this would result in a bonus or penalty applied to a practitioner at the end of his or her career, hardly what the government had in mind. But perhaps there is a simple way. When sophisticated patients look for a new physician or consultant they will usually enquire into the doctor’s reputation among his patients and his peers. In most cases this subjective measure of clinical stature will be highly accurate. At Schlesinger Pain Centers we believe that it might be best if the government simply set aside its plans for the measurement of medical quality and trusting in the inherent intelligence of the people strove to increase choice and access instead. It would seem logical that over time more patients would seek care with the better physicians and fewer would be forced to see poorer physicians. In this win/win approach the government would spend less money on poor care because fewer patients would choose to get it, but alas this approach is much too simple and logical to ever work?

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