A Foot in the Hospital Door
One of the theoretical advantages of managed care is that it can direct patients toward the safest and most cost-effective health treatments--in other words, it can manage effective care. But today, more than a decade after managed care became the primary medical provider for most Americans, the system might as well be mystery care. There is little publicly available data about the quality of doctors and hospitals and the usefulness of specific treatments.
One recent measure of the problem: a survey released earlier this year by the Washington Business Group on Health, which found just 22% of 360 executives saying they received any information at all about the quality of the health plans their employees use.
This cosmic void of data is why Californians should welcome an admittedly cursory survey of patient satisfaction with hospital care that the California HealthCare Foundation and a nonprofit think tank released this week. The survey had two glaring holes: Less than a third of California hospitals participated in it, and rather than collecting hard data about surgical success rates, nurse-patient staffing ratios and physician competence, it asked only whether patients experienced long waits, received pain medications and were treated with respect before surgery.
Despite its flaws, the survey has already inspired some healthy soul-searching at hospitals like UCLA and the Kaiser units, which had the courage to send out questionnaires to their patients but ranked average or below average on some criteria. In any case, hospitals that participated should probably be assumed to care more about patients than hospitals that refused.
The survey, available at www.chcf.org , should be just the start for a wider state effort to collect and publicly release hard data about quality of care in the state’s public and private hospitals. A state that can rate every public school ought to be helping consumers rate health care as well. Recently, the Office of Statewide Health Planning and Development did release its first public evaluations of how well California hospitals perform coronary artery bypass surgery. Its results (ranking Kaiser’s main L.A. hospital very high, for one) are a reminder that the patient satisfaction survey is hardly definitive. The next step is for the Pacific Business Group on Health, which helped conduct the bypass study, to add other common surgical procedures and treatments to its evaluations.
The patient satisfaction survey released this week should be welcomed, even though it may not tell us much about the practice of medicine at a particular hospital. It can be expanded. It is a foot in the door.
