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Avatar of Deborah Gordon

by Deborah Gordon

The Rise of U.S. Health Care Consumers: Lessons from Abroad

January 5, 2013 in health care costs, Health Insurance, International Health Care, Medical Care, Quality of care

Can you imagine buying gas from a station with no signs to let you know the prices? Or having the clerk at a clothing store pick the “right” jeans for you, with no opportunity to figure out for yourself which ones fit best? In a sense, this is how Americans buy something far more important: health care.

Economists and policy makers have long emphasized the challenges in treating health care as a consumer good. Supply generally drives demand; there is little correlation between cost and quality; and end users have neither visibility into costs, nor much incentive to find out. Lack of price transparency makes it nearly impossible to find health care cost information even for someone motivated to look for it. Consumers also have little basis for evaluating quality; often the data that is available is dense and hard to interpret. In other words, most Americans do not have the practice or capacity, let alone the information they would need, to make informed health care decisions.

But it does not need to stay this way – and, indeed, it cannot if health care reform is to succeed. Under the Affordable Care Act, 12 million consumers are expected to purchase their own health insurance via a health insurance exchange by 2014, growing to 28 million in 2019. Americans, including lower-income individuals qualifying for subsidized health insurance, will have new health plan choices, and new means of comparison shopping. Even without reform, health insurers are designing and employers are increasingly offering products that shift costs and choices to the consumer.

Remarkably, as a nation and a health care industry, we have not prepared our population for the increased responsibility and decision-making power they will soon assume. Yet there are places around the world that have a lot to teach us in this arena, and they’re not necessarily the ones you might guess – or the ones health economists tend to focus on. Read the rest of this entry →

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Avatar of Martha Bebinger

by Martha Bebinger

I want information about costs AND quality

January 1, 2013 in Medical Care, Quality of care

I’ve been thinking about this push from e-Patient Dave to redefine and rename “transparency.”

“If I mention ‘transparency’ to people in my community,” says Dave, “most have no idea what I mean. But when I say ‘We need to see what things cost – and nobody can tell us,’ everybody does see what a problem that is.”

And so, says Dave, what we need is “Visible prices, please. Before we make our purchase decisions.”

OK – no disagreement. Transparency is one of those wallpaper words.  Everyone uses it; but it feels plastic.  And, I strongly agree that we can’t make wise spending decisions about where to go for care if we have no idea how much anything costs.

Huntington Hospital in Pasadena, CA is one of the few hospitals I know of that posts prices for procedures, based on your insurance coverage.

But cost is only part of what we, patients, need to see in clear, user-friendly terms.

The other critical factor in choosing where to go for care is QUALITY.  Which doctor or hospital will give me the best results after knee surgery or the best chance of catching problems through a colonoscopy or the best normal delivery?

I don’t think any of us want to get to the point where we are buying care based on price alone.  So transparency, or whatever we call it, has to help us decide where to get the best care at the lowest price.  So Dave – what do we call that?  Don’t say “value.”  Anyone?

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Avatar of Martha Bebinger

by Martha Bebinger

Check out the differences in hospital quality across Massachusetts

December 3, 2012 in Quality of care

UPDATE: There were errors in the initial posting of our pneumonia quality numbers. We apologize for misrepresenting the quality of care for hospitals that looked worse than others in our original post.

Everyone seems to be talking about the “engaged” patient. Have you noticed? Fine, except there’s stunningly little information about health care with which I can engage.

Some of you are paying attention to how much your MRI or stitches or surgery costs. Tracking down the costs is hard. But try asking about the quality of that test or repair or the normal birth of a baby? Not only is the information hard to find, in many cases it doesn’t exist. It’s just amazing that I get a blank look when I ask, who does the best job with knee surgery or removing a gallbladder or a colonoscopy?

Hospitals say they are making great strides in gathering quality information. That’s great, but turning it into information we, consumers, can use still has a long way to go. And figuring out which doctors do a better job than their colleagues is nearly impossible to determine, expect by word of mouth.

We’re hoping to kick off a broad discussion about where to find the best care, starting with this snapshot of hospital quality in Massachusetts. The scores and ratings you see on the map and bar chart below are not new. This is all public data, collected by private, state or federal agents and posted online somewhere else. We’re pooling a range of quality measures here to offer you a glimpse of how much quality varies from one hospital to the next and to give you a place to ask your questions about what the health care system will and won’t tell you about quality and why.

If you don’t find what you’re looking for here, let us know. We are putting readers on notice: this the quality information that is available. We don’t think it’s good enough. Many hospitals agree. We all need to push for more. In the meantime, tell us what other quality information you’re looking for. We’ll see if we can help or let you know why we can’t.

Here’s a HUGE thanks to Dianne Finch who created the map and bar chart and to Ted Natoli who collected and packaged the data for this project.

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Avatar of Martha Bebinger

by Martha Bebinger

What’s a “good” colonoscopy?

November 23, 2012 in health care costs, Medical Care, Quality of care

No bad jokes.  I’m serious.

I’ve reached the wonderful age at which I’m supposed to have this test as part of my general health care.  I had one 10 or so years ago, so I know what I’m in for.  The best thing to be said is that the drugs gave me a deeply restful nap.

The first time, I went wherever my doctor told me to go.  This time, I have a couple of references from my doctor, but I’m going to ask some more questions before I decide whom will perform the delicate procedure.

I’ve talked to a few docs and looked at some websites.  Here’s my list of questions.  Is there anything I should add?

1)     About the prep – what will give me the best cleaning out with the least discomfort?  There’s no point in going through all this if the doc can’t see what s/he is doing.

2)     What’s the doctor’s detection rate?  One medical society (the American Society for Gastrointestinal

Borrowed from Asian Scientist where study found that 30% of colonoscopy patients had polyps.

Endoscopy) says a doctor should find a polyp in 25% of men and 15% of women (why the difference?), but I know that some physician groups around Boston say the average is 40-50% among docs who really look for polyps.

3)     How much time does the doctor spend, on average, on the test?  I think more is better, is that right?

4)     Does the doctor always get to the end of the colon? OK, I may not be able to ask this. Read the rest of this entry →

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