INTERNATIONAL/CONSUMERS: Consumerism meets single payer

So do the tappings of consumerism in health care need American-style CDHC? Apparently not, as in the UK the latest is that doctors are to be graded for quality of service

Every doctors’ surgery (surgery = office in Brit talk, not what it means in Yank-sih) is to be inspected and awarded Michelin-style stars so that patients can tell the quality of care offered by their GP at a glance, The Times has learnt. Expert panels will give family doctors one of three gradings in a move backed by ministers desperate to show that patients are getting value for money from huge GP pay rises. The scheme, being drawn up by the Royal College of General Practitioners, will run alongside government plans to publish detailed patient surveys of each surgery’s performance.

Of course the huge pay rises for GPs were as part of a pay-for-performance scheme…something their American colleagues might be a little envious about!

3 replies »

  1. Steve’s concerns are what has prevented any real improvements from occurring since the Flexner Report — in 1910. Yes, almost 100 years ago.
    My hope is that we will begin to do the best we can with the data that actually is available, and push to get better data over time. With respect to “a handful of practice guidelines”, following them will save lives and money right now. And yet, too often they are not followed. Do we need another handful of them? Sure. And then a handful after that. But the time to get started has long passed.

  2. You’re right, P4P is very tricky and vulnerable to many potential problems. Not surprisingly, the devil is in the details, i.e., how will care “quality” be measured and how will it help continually improved care?
    For example, if P4P metrics are based solely on claims/administrative data, patient satisfaction surveys, and rates of compliance to a handful of practice guidelines — as appears to be the case these days — the P4P incentives won’t do much to improve the overall effectiveness and efficiency (i.e., quality) of care.
    If, on the other hand, P4P metrics were based on valid clinical outcomes data, and were tied to continuous quality improvement programs incorporating evidence-based-knowledge feedback loops, advanced decision-support tools, and collaborative provider-researcher networks, then P4P could be useful in promoting widespread delivery of cost-effective care. This strategy takes commitment and vision.
    My concern is that our healthcare system will take a short-sighted, slip-shod, ineffective approach to P4P, reflecting its inherent tendency to avoid dealing with difficult details. If that’s the case, P4P will be a waste of time and resources, and will fail to stimulate sustainable improvements in care.

  3. Pay for performance is tricky that will require a LOT of variables to be factored into the equation. Here’s a little story to help you guys understand why.
    Many years ago in China, it was common doctors used a scheme to determine who the best doctors were. Every time one of their patients died, they would light a lantern and put it outside of their office. Patients could walk by, look at hte number/frequency of lit lamps to get a gauge on how good their doctor was.
    One man who lived in the area had been keeping tabs on the number of lamps lit by each doctor. One time, he suffered a snake bite on his leg and sought medical treatment. He scanned the doctors offices and noted that there was only one office with no lamps lit outside. He went to the doc and was treated. Just before leaving, the patient asked the doc “wow you must be the best doctor this town has ever seen, considering how you never have any lit lamps outside.” The doctor smiled and said, “well thats because you are my first patient.”
    Pay for performance is a lot more tricky than most people realize. There are all kinds of confounding variables that have to be accounted for.