Saturday, September 9, 2006
The terrific Ezra Klein has a new post on the problems with cosumer-driven health care, focusing particularly on the problem that most patients do not have the means or knowledge to evalutate accurately the health care they receive. He writes,
Over in the Wall Street Journal, more empirical scorn is being heaped on consumer-drected health care, this time in the form of a study showing that consumers have absolutely no idea what good health care is. Researchers from the Rand Corp., UCLA, and Department of Veteran's Affairs had 236 elderly patients in two major managed care plans rate the quality of their health care. Satisfaction was high, with the average rating a super 8.9.
Then the researchers sat down to rate the care these same patients received. They compared care received to care that should have been received, checking on fundamental metrics like whether a patient received aspiring within an hour of being diagnosed with acute myocardial infraction. Scores plummeted. Despite the high level of patient-satisfaction, the researchers gave the care a failing grade of 5.5. More interesting, the patients who rated their care as a 10 were just as likely to be getting low-quality care as those who reported a 5.
The problem? Patients are not qualified to evaluate good care. They're qualified to evaluate whether the doctor was nice to them, whether he explained things clearly, whether the wait time was short and the experience pleasant. They do not know how well their care matched up to accepted standards of care, and they do not know whether the treatments they were given were comprehensive, well-targeted, or adeptly conducted.
Oops! Read the rest of his entry and the comments - very illuminating.