Module Components

• Overview
• Assignments

Topics

• Quality of Health Care
• Cost of Health Care
• What is Costing SO MUCH??

Nurs 690 Managerial Health Finance

Module 4: Quality and Cost of Health Care

Overview

When it comes to improving healthcare in the United States, most discussions revolve around the twin pillars of quality and cost: Will higher expenditures result in better care, or will better clinical outcomes help to contain costs? In a review of the evidence currently available, there was no clear relationship between quality and cost, and the association between healthcare cost and quality is still poorly understood.

Lead author Peter S. Hussey, PhD, from RAND Health, Arlington, Virginia, and colleagues conducted a systematic review of 61 studies and "found inconsistent evidence on both the direction and the magnitude of the association between health care costs and quality. The authors conclude, "To our knowledge, there has been no previous systematic literature review of evidence on the cost–quality association in health care."

One problem Dr. Hussey and colleagues found was that studies varied widely in the way they defined costs and in the levels of analysis they employed. However, the findings remained inconsistent even after Dr. Hussey and colleagues controlled for these differences. "These results are a stark reminder of how little researchers and caregivers know about the optimal allocation of scarce health care resources to achieve the best health outcomes," Alyna T. Chien, MD, from Harvard Medical School and Boston Children's Hospital in Massachusetts, and Meredith B. Rosenthal, PhD, from the Harvard School of Public Health, write in an accompanying editorial.

Chien and Rosenthal conclude that more data are needed for clinicians and policy makers to make effective decisions that affect the clinical and fiscal health of the nation. They urge physicians to learn more about the cost and price of the services they provide and recommend that funders of research support studies that evaluate the cost or cost-effectiveness of the interventions in question. Payers should reconsider the extent to which they shift financial risk onto provider organizations, and incentives for quality targets should be offered to promote processes of care that are well-supported by evidence or, conversely, to discourage care shown to be inappropriate or of poor value. In this module, we explore the importance of quality, cost, and health care financing.

Objectives

At the conclusion of this module, the learner will be able to:

• Describe the relationship of cost and quality in health care.
• Discuss the domains of quality.
• Compare the different sources of information on quality.