Do You Get What You Pay For in Health Care?
An interesting new web site claims to offer consumers the opportunity to shop for hospital care based on a combination of cost and quality of care. NerdWallet Health allows consumers to select a medical condition and a geographic area, and returns a list of local hospitals treating that condition. The list includes such variables as patient satisfaction, number of patients with that condition treated per year, and the average charge for treating the condition.
The site has significant limitations right now–only a few medical conditions are listed, and not all hospitals appear on the search results. But what jumps off the page is the wide disparity in the cost for presumably similar treatment. Take knee and hip replacements, for example. According to NerdWallet, the charges range from a low of just over $19,000 at Winchester Hospital and Mt. Auburn Hospital to $47,000 for Milton Hospital, to a whopping $64,000 for Brigham & Women’s Hospital.
It’s hard to explain this discrepancy based on quality of care alone. Brigham & Women’s is without doubt a world-renowned institution, but is its care really worth three times more than Mt. Auburn, a well-respected community teaching hospital? And the added costs associated with the staff and facilities and teaching hospitals is significant, but how does Milton Hospital—another community hospital–explain that its charges are nearly two and a half times those of two fairly similar institutions, Winchester and Mt. Auburn?
Cost apart, the site gives very little information about how quality is determined. Patient satisfaction is important–but is a happy patient the best indicator of quality care? One piece of information that is useful is the number of similar patients treated each year. Would you rather have your knee or hip replaced at an institution that performs 28 procedures a year (Carney Hospital) or more than 1400 (New England Baptist)? What about the experience of the individual surgeon? The skill of the anesthesia team? The training and attention of the nursing staff?
It strikes me that NerdWallet’s approach, focused on cost, isn’t particularly helpful to consumers–either those seeking bargains or those seeking the best care. There simply isn’t enough information to allow people to make rational assessments of whether the cheapest hospitals are providing high quality care in an efficient manner–or whether they are simply cheap. On the other hand, how can anyone judge whether the high-end teaching hospitals are truly worth the price they command–perhaps because of market factors unrelated to quality.
It’s an interesting collection of data to look at, but it serves only to underscore one of the major problems for patients/consumers: how to judge the quality of care provided by a particular hospital–let alone an individual doctor at a particular hospital. There are so many factors that are difficult to impossible to quantify, and even where data exists, it’s not usually publicly available. Until more truly reliable information is made public, consumers will inevitably make decisions based on extraneous factors.