Quality Gains Key to Health Care Reform

Article excerpt

WASHINGTON -- Quality improvement must be an integral part of any health reform plan, according to one expert.

Although there have been many improvements in medical care over the past few years, "with the miracles have come burdens," Dr. Donald Berwick, president and CEO of the Institute for Healthcare Improvement, said at the annual meeting of the American Health Lawyers Association. "Miracles and hazards come hand in hand."

Improving the quality of health care doesn't necessarily mean spending more money; in fact, the opposite is often true, Dr. Berwick said. "England spends 8%-8.5% [of its gross domestic product] on health care--about half of what we do--and has equally fine care." And the Dartmouth Atlas Project has found that regions of the United States that spend the most on health care--areas with more hospital beds per capita and more specialists, and where more procedures are done--often have worse care outcomes.

"They have higher mortality and the same functional status among patients" as do those in lower spending areas, he said. "Doctors in these areas report more problems with continuity [of care], and patients are less satisfied."

The biggest predictor of quality of care by far, however, is race, Dr. Berwick continued. "If you are black, that is the biggest count against you for health status; that's not true in the rest of the developed world." A black male child born in inner-city Baltimore this year, for instance, has an 8-year-lower life expectancy than does a white child, he said. Using a strictly market-based approach won't solve quality problems, according to Dr. Berwick. "I simply do not think markets will work in health care," he said. "But I think there is a way out, and it has to do with leadership."

The health care system has to allow for the fact that people see what they expect to see and interpret the world accordingly, which can lead to errors in the operating room and other health care settings, Dr. …