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September
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DOW JONES REPRINTS
In Health Care, It's fashionable these days, particularly in Washington, to argue that the best way to improve the quality and restrain the cost of health care is to make the market for health care more like the market for everything else. The theory: Give consumers more information, let them choose the best provider and the resulting competition will help to squeeze out costly waste and ineffective care. After all, markets work pretty well for other goods and services. The notion has some appeal, and a dose of market medicine would help some of what ails the nation's health-care system. But as a cure, the approach rests on the belief that health care is -- in most respects -- like any other product. An intriguing new comparison of patient-satisfaction surveys and medical records suggests one big way in which health care differs. The bottom line: Just because patients say they're very happy with their doctors and the care they're receiving doesn't mean they're getting good care, as defined by medical experts. CAPITAL EXCHANGE
DIG DEEPER • For more on the That makes health care an anomaly. If you go to a restaurant and like the food, it doesn't matter whether the local restaurant critic agrees with you. If you think an airline offers a good price at a convenient time on a flight and treats you well, who cares what the travel Web sites say. If you like the car, the heck with the auto guidebooks. But health care? Researchers from the Rand Corp. think tank, the University of California at Los Angeles and the federal Department of Veterans Affairs asked 236 elderly patients at two big managed-care plans, one in the Southwest and the other in the Northeast, to rate the medical care they were getting. The average score was high -- about 8.9 on a scale from zero to 10. Asked questions such as "How often did doctors and other health-care providers listen carefully to you? Did they explain things in a way you could understand?" patients rated their caregivers' communications skills even higher -- at an average of 9.2 on a 10-point scale. Americans as patients, in at least this respect, resemble Americans as voters. They often condemn the system, but they like their own connection to it. A recent Wall Street Journal/NBC News poll found 60% of the public disapproves of Congress, but a significantly smaller 48% wanted to replace their own congressman. In the second part of their study, the medical researchers systematically examined 13 months of medical records to gauge the quality of care the same elderly patients had received, using a comprehensive measure of quality developed by Rand's Assessing Care of Vulnerable Elders program. (An example: "If a vulnerable elder has an acute myocardial infarction or unstable angina, then he or she should be given aspirin therapy within one hour...") The average score wasn't as impressive as those in the patient-satisfaction surveys: 5.5 on a 10-point scale. But here's the interesting part: Those patients who graded the quality of their care as 10 weren't any more likely to be getting high-quality care than those who gave it a grade of 5. The most-satisfied patients didn't get better medical care than the least-satisfied. "Patient ratings of health care are easy to obtain and report," says John T. Chang, a UCLA physician and lead author on an article summarizing the research in the journal Annals of Internal Medicine. That's one big reason they are so popular among managed-care plans and hospitals. Another reason, Dr. Chang says, is that "people who respond to surveys in general tend to be those who are satisfied; those who aren't satisfied tend to leave the [health] plan." "But," he adds, the surveys "do not accurately measure the technical quality of medical care." With restaurants, or movies, or airplane rides, or even newspapers, customer satisfaction can be almost the whole story. Not so in medicine. "Patient ratings reflect some important things, but not whether [patients] are receiving recommended care," says Robin Hertz, a researcher at drug maker Pfizer Inc., which helped fund the research. It's not the last word, of course. It's a sample of 236 elderly patients in two health plans. Dr. Chang, however, argues that the elderly are the right group to study in this regard because they have more contact with the health-care system than the average nine-year-old. Satisfying patients matters. Patients deserve doctors, nurses and other health-care providers who have a gentle touch and a knack for explaining the complicated. Doctors, nurses, hospitals and insurance companies ought to treat patients as customers, not as autos on an assembly line, and they deserve to lose business if they don't. But confusing high scores on patient-satisfaction surveys with high-quality medical care can be dangerous to your health. • Send
comments to capital@wsj.com4
and see a Q&A next Thursday at WSJ.com/Capital5.
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