Quality and Effectiveness Enter the Debate

Two stories from today's papers suggest that the coming debate over health care reform may be more informative than the last time the nation, via the Hillary-care proposal, sought to adopt a universal system of coverage. Key to creating a long-term affordable system that covers everyone is reforming the health care system itself, which requires improving quality and lowering the cost of medicine. One way to lower cost is to get rid of useless procedures and tests.

On that score, a new study in the Journal of the American Medical Association showed that CAT scans for early detection of lung cancer among smokers did not reduce the death rate. A previous study by a radiologist had suggested people lived longer. It turned out that was merely an artifact of earlier detection coupled with false positives identified by the CAT scans (the test probably identified minor tumors that would never have proven fatal or even malignant if left untreated).

The second story comes from the New York Times' David Leonhardt, an economics correspondent who understands health care. Today, he reports on the movement to require hospitals to report quality indicators, which are now reported on a Medicare website. His example is the time hospitals take to treatment for heart attack patients. The longer it takes, the more likely the victim will suffer permanent disability or death.

In theory, requiring the reporting of these times would provide consumers with more information so they can choose which hospital to drive to. But how likely is a person in the midst of a heart attack to do that? How likely is an ambulance driver going to go past one hospital because the one five miles down the road delivers better care? That's a lawsuit waiting to happen.

Yet publication of data has gotten hospitals to improve their performance. How? It turns out that peer pressure is a powerful incentive. Having bad ratings forced the hospital -- in Leonhardt's example, the University of California at San Francisco -- to dramatically cut the time heart attack patients spent waiting for treatment.