Cost-Quality Tradeoffs in Health Care Part 2

Is it better for health care providers to go high-tech and high-service? Or is a frill-free, full-spectrum care provider preferable? How do hospitals that adopt these different approaches stack up on measures of quality and patient experience? I asked these questions last week after receiving mailers from two local hospitals. To find some answers, I visited a new, government-sponsored website, and followed links to the Hospital Compare tool. Comparing quality measures from two local hospitals side-by-side gave some surprising answers.

Before comparing the two health care providers, I assumed that patients would prefer the high-tech hospital. Although I had not visited this care center, a miserable experience at the frill-free hospital made it hard to imagine any provider could be worse. The high-tech hospital boasted of a patient-centered focus while my hospital offered a urine-soaked bed and numerous hand-offs between providers. As a result I expected the high-tech hospital to rank higher in patient satisfaction quality scores.

Although I expected the patient satisfaction scores for the high-tech hospital to be higher, I was skeptical that the quality scores would differ. Familiarity with the Dartmouth Atlas and other research has shown me that higher-spending hospitals don't always provide superior health care than others. With advertised preferences for the latest imaging technology and high-cost (and high-revenue) procedures, I assumed that the high-tech hospital spent more per patient. I did not know how this would affect the process and outcome quality measures but guessed that the health care providers would at least be equal.

These estimates were almost entirely incorrect. On 8 of 10 patient experience measures, including "percent of patients who gave their hospital a rating of 9 or 10 on a scale from 0 (lowest) to 10 (highest)" and "percent of patients who reported YES, they would definitely recommend the hospital", the low-frills hospital outranked the high-tech hospital. The hospital where I suffered a dirty bed even edged the fancy hospital on the measure of "percent of patients who reported that their room and bathroom were "Always" clean." Both hospitals lacked sufficient data to compare quality across outcomes of care such as mortality and readmissions, but the low-frills hospital surpassed the high-tech hospital on the majority (7 of 10) of process of care measures. These include "percent of surgery patients that received the correct antibiotic" and "percent of surgery patients who received appropriately timed blood clot treatment."

The findings offered by the Hospital Compare website demonstrate that full-spectrum hospitals that lack the newest imaging technologies or procedures still offer care comparable or superior to fancier neighboring hospitals. This is good news for health care decision-makers hoping to cut costs and bad news for patients that prefer creature comforts in the hospital - like clean beds.

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