Monday, September 11, 2006
Consumer directed care: another empty promise?
The big push right now is for consumer directed care, and it's based on the theoretical assumption thaht if we treat health care like any other market -- allowing consumers free rein to purchase the services they like best -- the results will be higher quality care. A recent study suggests not:
Researchers from the Rand Corporation's think tank, the University of California at Los Angeles and the federal Department of Veterans Affairs asked 236 elderly patients at two big managed-care plans to rate the medical care they were getting. The average score was high — about 8.9 on a scale from zero to 10.
Then they poured through 13 months of medical records to gauge the quality of care the same elderly patients had received and found an average score wasn't as high as those in the patient-satisfaction surveys: 5.5 on a 10-point scale.
But here's the kicker: Those patients who graded the quality of their care as 10 weren't any more likely to be getting high-quality care than those who gave it a grade of 5. The most-satisfied patients weren't getting any better medical care than the least-satisfied.
Patients, it seems, are rather poor judges of whether they're getting good care. And if consumer preferences don't map to high quality care, then a free market in health care won't necessarily produce better results or higher efficiency. Don't expect mere facts from mere scientific studies, however, to slow down the political rush to consumer-directed care. The politicians know that: 1) this stuff buys votes, and 2) by the time we all figure out it was another false promise, they'll all be safely out of office.
Researchers from the Rand Corporation's think tank, the University of California at Los Angeles and the federal Department of Veterans Affairs asked 236 elderly patients at two big managed-care plans to rate the medical care they were getting. The average score was high — about 8.9 on a scale from zero to 10.
Then they poured through 13 months of medical records to gauge the quality of care the same elderly patients had received and found an average score wasn't as high as those in the patient-satisfaction surveys: 5.5 on a 10-point scale.
But here's the kicker: Those patients who graded the quality of their care as 10 weren't any more likely to be getting high-quality care than those who gave it a grade of 5. The most-satisfied patients weren't getting any better medical care than the least-satisfied.
Patients, it seems, are rather poor judges of whether they're getting good care. And if consumer preferences don't map to high quality care, then a free market in health care won't necessarily produce better results or higher efficiency. Don't expect mere facts from mere scientific studies, however, to slow down the political rush to consumer-directed care. The politicians know that: 1) this stuff buys votes, and 2) by the time we all figure out it was another false promise, they'll all be safely out of office.
