Can global competition bring health care quality?

Illinois Blue Cross has become the latest carrier to state it will no longer pay for mistakes at hospitals.

Since last year a flood of insurers have claimed they would never pay for "never events" -- like leaving stuff in the patient after an operation. Some have even detailed what they won't pay for.

But will this really have an impact? Won't hospitals just roll up the cost of the losses into the bills charged patients who come out OK?

The only way it can work, wrote President Ravi Pandey of BIPRO International, which works in the area of quality management, is to open up the healthcare market to global competition.

"There is no competition unless you open up healthcare to global market," he wrote to the Wall Street Journal healthcare blog. "Which in turn will require fundamantal changes in the business model."

At his own blog Pandey called this new business model Pay for Performance, or P4P.

When Pandey wrote about this, his own commenters gave him something of a hiding. One wrote that this would discourage hospitals from performing difficult work. Others worried about measurement criteria.

My view is a key to any P4P scheme has to be transparency, solid information insurers and consumers can use to make informed choices.

In the past this was known as "reputation," but when marketing dollars are used to buy reputation, numbers must replace it.

Publicly-available measurements, then, and a single global market based on those measurements, will allow the cream to rise to the top.

Think that's happening any time soon? And if we can't get it, how are we going to create a P4P scheme that works?