ECON 440 Lecture Notes - Lecture 11: Iatrogenesis, Revealed Preference, Management System
13 Jun 2018
School
Department
Course
Professor
What is high/low quality health care?
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What are quality problems? Why do they exist?
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What are their strengths and weaknesses?
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What are ongoing challenges?
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What efforts exist to improve quality?
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Outline
High Quality - "The degree to which health services for individuals and populations increase the likelihood
of desired health outcomes and are consistent with current professional care"
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Safe
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Effective
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Patient-centered
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Timely
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Efficient
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Equitable
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Care should be:
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High Quality Health Care
Overuse: using resources and procedures in the absence of evidence they will help
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Underuse: failure to employ practices of proven benefit
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Misuse: failure to execute clinical care plans and procedures properly - medical errors
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Between 44,000 and 98,000 deaths per year in us hospitals are due to preventable medical
errors (IOM 1999)
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185,000 Canadian hospital admissions are associated with an adverse event each year, about
70,000 of which are preventable (Baker et al 2004)
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Medical errors, negligence, complex drug interactions
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Iatrogenic effects: adverse effects or complications resulting from medical treatment or advice
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Low Quality Health Care
Patient's objectives: what do they care about?
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Little information about quality
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What incentives do they face?
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Fees that insurers pay providers reflect intensity (training, time, effort), not quality
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Patient demand doesn't respond strongly to quality, so quantity doesn't change much
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"No business case for quality" (Coye 2001)
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Provider's objectives: what do they care about?
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Heterogeneous providers and patients
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Payers' objectives: what do they care about?
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In systems with multiple players and mobile enrollees/patients
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In systems with single payers
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Insurers don't have/exert much control over clinical practice
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Why Doesn't the Market Provide High Quality Care?
Decide which outcomes are important and how to measure them
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Levels and/or improvement
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Clearly identify goals
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Design and implement interventions with attention to both the demand and supply sides
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Evaluate and repeat
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How Do We Improve Quality?
Recovery, restoration of function, and survival: the ultimate indicators of the effectiveness and quality of
medical care
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Quality Measurement: Outcome
Lecture 11 - Health Care Quality
Wednesday, February 14, 2018
5:49 PM
ECON 440 Page 1
