Phasing Out the Dickens System
American hospitals are treasure troves of individual excellence in medical care, but the bad news is that not every hospital--and not every doctor--is as accomplished as the next. The health care system unfortunately does little to help consumers distinguish good from bad.
While our consumer culture provides report cards on everything from automobiles to schools, the scattershot information on medical performance that health insurers, hospitals and others do collect is generally shrouded in secrecy.
The veil will be lifted a little in early December with the release of California’s first major report on health care quality, specifically a study on death rates following coronary bypass surgery in California hospitals.
The study was conducted by the Office of Statewide Health Planning and Development and the Pacific Business Group on Health, a coalition of large employers whose medical director, Arnold Milstein, has been lobbying for such a study for more than four years. Since heart disease is the No. 1 killer of Californians, the study should be an invaluable tool in giving consumers basic information they need to make informed health care decisions.
Similar to a study of coronary bypass surgery conducted in New York state over the past decade, California’s coronary artery bypass graft study takes into account the age and degree of illness of patients so hospitals aren’t penalized for having caseloads of relatively sick people.
Milstein admits that the study has a “huge weakness”: While participation in New York’s survey is mandatory for all hospitals, California’s survey is voluntary, and so only 79 out of the 118 hospitals in the state that perform more than one heart bypass a week are rated. More troubling, while the New York study measures individual surgeons, the California study does not.
Market pressure could solve part of the problem. Powerful health insurance buyers in the state, like large employers and the California Public Employees’ Retirement System, should encourage better studies by refusing to contract with hospitals that do not participate.
Gov. Gray Davis should call on the state health planning office to measure the performance of individual surgeons and to emulate Pennsylvania, which collects mortality data not just on heart surgery but also on 14 other major conditions and procedures, including stroke, pneumonia, hip surgery and lung cancer.
As Milstein points out, “America, with an industry as high-tech as health care, should not be using an information system out of Charles Dickens.”
