Would a Ratings System Improve Health Care?

ABC News asked a panel of experts five questions about what it would take to fix the health care system, including physicians, business school professors and consumer advocates.

Below is the second batch of answers they brought back for this five part series -- some surprising, some simple.

Question: What's the way to improve health care quality in America?

Dr. Alan Garber

Director, Center for Health Policy, Stanford University

Despite all the talk about improving quality, we pay doctors and hospitals that provide substandard care just about as much as we pay doctors and hospitals that provide superior care. We need better ways to measure the quality of care, and we need to pay less for poor quality care, and pay more for high quality care.

Dr. David Gratzer

Senior Fellow at the Manhattan Institute, and a licensed physician in the United States and Canada. Gratzer wrote "The Cure: How Capitalism Can Save American Health Care"

Quality will come from competition. As different providers innovate, we will find ways of better building the health care "mousetrap." Unfortunately, state and federal governments have spent the last 60 years undermining competition.

Regina Herzlinger

Senior Fellow at the Manhattan Institute and the Nancy R. McPherson professor of business administration at the Harvard Business School

That which gets measured, gets managed. Measure it; audit the data, and make them readily available. If I needed a mastectomy, I would want to know how good my doctor is in performing this kind of surgery on people like me, wouldn't you?

Dr. Joanne Lynn

Physician and researcher with the Department of Health and Human Services' Office of Clinical Standards and Quality at the Centers for Medicare and Medicaid services

We are coming a long way in making quality visible, though we have a long way to go. Quality is going to mean different things to different people. For the young mother, nothing is as important as protecting the health of her baby. For the elderly person facing frailty and self-care problems, reliable long-term support for nutrition, hygiene, and comfort are important. We will need to customize our understandings of quality and value to the priorities of people facing different kinds of challenges and opportunities.

Lisa McGiffert

Senior policy analyst at Consumers Union, publisher of Consumer Reports

It is a travesty that we spend so much for health care but perform so poorly on basic measures of quality. We need accountability so everyone can get good quality care and make informed choices about their options.

We need to arm purchasers -- individual consumers and employers -- with useful information about the quality of the care delivered by hospitals, doctors, pharmaceutical companies, and the plethora of others in the medical community.

We need to know who provides safer care (see www.StopHospitalInfections.org), which drugs and treatments are more effective (see www.CRBestBuyDrugs.org; www.CRMedicalGuide.org), and when drug companies hide negative results of their clinical trials (see www.PrescriptionForChange.org).

Our government should play a strong role in assuring that our health care dollars are being spent on treatments and services that work and not on harmful and wasteful practices. Publishing health care quality reports also shows hospitals, doctors, and other health care providers how they stack up against their peers and motivates them to improve their outcomes.

Robert E. Moffit

Director, Center for Health Policy Studies, The Heritage Foundation

Beyond intense competition, transparency. Doctors, hospitals and health plans should be held directly accountable for their performance by patients and consumers, armed with the best information from both public and private sources. Developing standards of quality care should be the exclusive responsibility of medical profession and specialty societies. In the case of medical professionals and hospitals, this means the success they have in treating medical conditions and curing disease. Results, not process, should be the operative principle. In the case of health plans, this means independent evaluations based on the delivery of insurance services, as well as consumer satisfaction surveys. The government can play a role in making such information available. Under no circumstances, however, should the government exercise monopoly control over either the production or distribution of such information to the public. Monopoly would be counterproductive. The information should be easily accessible from institutions and organizations that Americans know and trust. Medical associations, business organizations, unions, ethnic, fraternal, religious and consumer groups, especially, can and should play a decisive role in this process.

Debra Ness

President, National Partnership for Women and Families

The best way to improve care is to start measuring performance and publicly reporting the results. What gets measured gets improved, and publicly reporting how doctors, hospitals and health care providers perform will drive dramatic improvements. Right now you can learn more about the quality of a restaurant or a toaster oven than a doctor or hospital, and that needs to change.

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