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In its June 22, 2002, issue the British Medical Journal informs about
a new report by the Commonwealth Fund on the gaps in health care quality
in the United States. The BMJ cites the statement of the author of the
report, Professor Sheila Leatherman, that "quality problems can't be cured
by simply spending more money" and that "the US already spends more [...]
than any other nation".
I agree that spending more money does not ensure higher quality of
care (for example, if money is used to provide unnecessary services or to
increase wages). On the other hand, it would be wrong to conclude that
improving the quality of care does not require more money. Reducing
underuse problems usually increases spending even if savings from
preventing future complications are taken into account (Chapman 2000). But
eliminating overuse and misuse may also lead to higher expenditures
because the costs to set up and maintain a quality improvement program may
be higher than downstream savings from avoiding unnecessary or harmful
interventions.
The fact that the U.S. spends more on health care than any other
nation does not change this argument. Many of the reasons for the high
expenditures of the U.S. are related to the structures of the U.S. health
care system and are not linked to the processes or delivery of health
care, for example the high wages and administrative costs (Dorsey 1996).
References
1. Chapman RH, Stone PW, Sandberg EA, Bell C, Neumann PJ. A comprehensive
league table of cost-utility ratios and a sub-table of "panel-worthy"
studies. Med Decis Making. 2000;20(4):451-67.
2. Dorsey L, Ferrari BT, Gengos A, Hall TW, Lewis WW, Schetter CO. The
productivity of health care systems. McKinsey Quarterly 1996;4:121-31.
Competing interests:
No competing interests
29 June 2002
Afschin Gandjour
Institute of Health Economics and Clinical Epidemiology, University of Cologne
My Oxford Dictionary of Current English offers in first
place, degree of excellence as the meaning of quality.
Regretably, in my view, healthcare standards measured
principally from the providers view outward tend to compete
with their own self-images rather than efficiently measure
thorough effective services given. While a vast compendium
of services can be held to measure these, in themselves, do
not create "excellence" standards when there are so many
needs and options unrepresented or ill considered.
Additionally full and reasonable transitions to effective
self-managed complementary care are so seldom given the
attention they deserve, at least in the US styles of
service, that such a large portion of the actual healthcare
work remains undone in routine service. One can hardly think
of the word excellence (or quality) amidst this context. Not
to belittle vast amounts of excellent work provided but our
system leaves so much undone, unrepresented. Quality
discussions then sound more like staged honorifics.
Can the quality of U.S. health care be improved without increasing expenditures?
In its June 22, 2002, issue the British Medical Journal informs about
a new report by the Commonwealth Fund on the gaps in health care quality
in the United States. The BMJ cites the statement of the author of the
report, Professor Sheila Leatherman, that "quality problems can't be cured
by simply spending more money" and that "the US already spends more [...]
than any other nation".
I agree that spending more money does not ensure higher quality of
care (for example, if money is used to provide unnecessary services or to
increase wages). On the other hand, it would be wrong to conclude that
improving the quality of care does not require more money. Reducing
underuse problems usually increases spending even if savings from
preventing future complications are taken into account (Chapman 2000). But
eliminating overuse and misuse may also lead to higher expenditures
because the costs to set up and maintain a quality improvement program may
be higher than downstream savings from avoiding unnecessary or harmful
interventions.
The fact that the U.S. spends more on health care than any other
nation does not change this argument. Many of the reasons for the high
expenditures of the U.S. are related to the structures of the U.S. health
care system and are not linked to the processes or delivery of health
care, for example the high wages and administrative costs (Dorsey 1996).
References
1. Chapman RH, Stone PW, Sandberg EA, Bell C, Neumann PJ. A comprehensive
league table of cost-utility ratios and a sub-table of "panel-worthy"
studies. Med Decis Making. 2000;20(4):451-67.
2. Dorsey L, Ferrari BT, Gengos A, Hall TW, Lewis WW, Schetter CO. The
productivity of health care systems. McKinsey Quarterly 1996;4:121-31.
Competing interests: No competing interests