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03-01-2013 | Article

Healthcare cost versus quality conundrum stymies clear policy decisions

Abstract

Study abstract

medwireNews: The body of literature describing the association between healthcare quality and costs is unclear, with evidence for the direction and magnitude of this link largely inconsistent, shows a systematic review in the Annals of Internal Medicine.

The findings reveal the convoluted nature of healthcare expenditure and touches on the ongoing policy debate as to whether healthcare spending cuts will negatively impact quality of care, or if quality improvement will reduce healthcare expenditures.

"It's a really important issue for policymakers to understand. Unfortunately, there isn't a clear finding that emerges from this body of literature for policymakers as to what the relationship is," explained primary author, Peter Hussey (RAND Health, Virginia), to medwireNews. "Even [in] studies that found an association [there is] not a huge effect of quality that is associated with big differences in spending."

Policy makers, according to Hussey, focus on variations in spending across regions when one congressional district experiences higher costs than another. "When you are trying to improve healthcare a lot of the things happen at the provider level or among specific patient populations," Hussey said. "I think it is worthwhile to look at those studies as well but they didn't get quite as much attention."

In an accompanying editorial to the study, Alyna Chien and Meredith Rosenthal (Harvard University, Boston) emphasize that physicians lack an understanding of the costs of the services they provide and how they relate to care quality.

"People don't realize how little doctors know about the cost of the care they deliver," Chien told medwireNews. "Absent any good data about cost the general leanings are towards 'more is better' when more could be harmful or wasteful."

Both Chien and Hussey see advantages in informing patients about the risks, benefits, and overall appropriateness of a treatment as it could empower decisions that lead to better outcomes and reduced costs. "But how you get there is the big part of the puzzle," Hussey observed. "Identifying wasteful care and eliminating it is still really difficult. It's not as easy as just reducing spending that wouldn't hurt quality."

For Chien, much of the issue relates to drastically different perspectives that providers, payers, and patients have on the issue, which a transparent accounting system and incentives could mend. "You need disparate groups to come together and recognize they are playing a crucial part in the problem and the potential solution," she said.

By Peter Sergo, medwireNews Reporter