The Global Pursuit Of Health Care Quality

PROLOGUE: Readers looking for a bright spot in the quality fieldmay be disappointed by what the following papers reveal: Thegrass isn’t any greener in our neighbors’ healthcare yards, and in some places it’s even more patchy.The papers in this group address perceptions, measures, responses,and incentives related to health care quality in private fee-for-serviceand national universal coverage systems. Because so few comparableindicators exist, although many systems are measuring numerousaspects of health care quality, developing meaningful comparisonsof quality performance is a challenge. Peter Hussey and a multinationalgroup of authors tackle this in their paper and ultimately comparetwenty-one quality indicators in five countries to make somestartling discoveries. It is common knowledge that the UnitedStates spends more per capita on health care than any othercountry and yet ranks nowhere near the top in measures of lifeexpectancy or infant mortality. But what about other qualityindicators, such as survival after organ transplantation orvarious cancers? Is the U.S. dollar buying better outcomes withits prevention dollars? In a Perspective on this piece, BethMcGlynn shares insights into what it would take to make seriousinroads to improve health care quality around the world, stressingthe value of measuring what we do to improve patient care, ratherthan what we spend.

The absence of a central repository for information on qualityfailures and powerful disincentives to report such events combineto create a dearth of data on major quality failures, as KieranWalshe and Stephen Shortell discuss in their paper. Health carequality failures rarely directly endanger the provider community,because the affected patients bear the brunt of the failures.Thus, professional ethics, an ephemeral concept at any time,are sometimes the only force motivating providers’ participationin the quality crusade. How then can health care systems bereoriented to reveal mistakes, encourage information sharing,and avoid victimization and protectionism?

Are direct monetary incentives, recently introduced in the UnitedKingdom and discussed in Peter Smith and Nick York’s paper,the answer? Here individual general practitioners (most in grouppractices) will receive specific rewards if they adhere to specifiedquality practices, including gathering and recording informationand communicating with patients. While the devil may lurk inthe details, the United Kingdom has enlisted its GPs in a nationwidepush to improve primary care quality. In the final paper inthe group, Robert Blendon and colleagues’ survey of hospitalexecutives in five English-speaking countries, exploring a rangeof topics from resources and staffing levels to public reportingand quality improvement efforts, makes for surprising reading.

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