Can global competition bring health care quality?

Can global competition bring health care quality?

Summary: 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.


BIPRO logoIllinois 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?

Topics: Enterprise Software, CXO, Health, Software, IT Employment

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  • Medicine is best done up close and personal

    ...and it's bad enough that patients in rural areas often have to go to distant cities without our sending people to foreign countries.

    We need a much more competitive system, but that's best done locally.
    John L. Ries
  • Globalization has nothing to do with quality.

    Any nation can direct its resources to quality on its own. We happen to be wasting health-related resources on excessive liability payouts, regulatory compliance costs, coverage mandates, and quite frankly - health incidents that are people's own fault! How many E.R. visits are due to drunken-driving accidents, drug overdoses, etc.? Quite a few. How many STD-related costs have been injected into the system, due to lack of personal character? Tons. Just getting started...the biggies in the past have been smoking and the related cardio-pulmonary diseases; how about the overeating/underexercising and drinking soda - we now are seeing huge increases in diabetes. Much of these are the direct result of personal choices. You can't globalize that away.

    The correct legal changes and financial structures can yield big improvements. But bigger still would be the change wrought by better lifestyle and character choices.
    • What is wrong with competition?

      Shouldn't we have free trade in health care?
      • Competition is good

        Both TechBoy and I have said so repeatedly, but it seems to me that part of containing the cost is bringing adequate care to where people live (lots of folks live nowhere near the big city), instead of requiring that they travel long distances to get what they need. As we're all now painfully aware, traveling from point A to point B costs money, as well as time.

        Globalization might be good at getting people cheaper electronics, but I don't think it does very much for medical care.
        John L. Ries
  • Good luck making apples to apples comparisons

    Sites likie and others like that try to make fair comparisons between like hospitals, but you have to be fair when evaluating quality. Remember, some hospitals will be "set up" to fail more than other comparator facilities. For example, the big inner-city teaching hospital will take on tougher cases, be compensated less (more self-pay, bad debt, indigent care cases) yet be expected to post sterling performance results. The suburban non-teaching hospital with better-insured patients may look better on paper simply because their patients may be in a better financial position to comply with their therapy (i.e., get their Rx's filled, get to follow-up appointments, go to rehab, etc)
    And remember the human element - some patients may still have negative outcomes despite doing everything perfectly. P4P may help the health care system improve somewhat, but there are many variables that should be considered besides arbitrary rankings of quality.
    • Thanks RxDoc

      Setting the measuring sticks so that they're fair to all is very important, you're right.
  • RE: Can global competition bring health care quality?

    Quality and Cost are two sides of same coin. And I am not saying globalize everything..If you do it blindly, it might fail as it did for many of the medium size companies.

    Dana, I am will be publishing 2 parts article on this- one tomorrow and another one week after at to provide a higher level strategy for globalization.


    Dr. R.K. Pandey
    PS: The article you refered has a change in address due to IT issues..the new address is
    Dr. R.K. Pandey