High and Rising Health Care Costs. Part 4: Can Costs Be Controlled While Preserving Quality?

5 July 2005 | Volume 143 Issue 1 | Pages 26-31

Several interrelated strategies involving physician leadership and participation have been proposed to contain health care costs while preserving or improving quality. These include programs targeting the 10% of the population that incurs 70% of health care expenditures, disease management programs to prevent costly complications of chronic conditions, efforts to reduce medical errors, the strengthening of primary care practice, decision support tools to avoid inappropriate services, and improved diffusion of technology assessment.

An example of a cost-reducing, quality-enhancing program is post-hospital nurse monitoring and intervention for patients at high risk for repeated hospitalization for congestive heart failure. Disease management programs that target groups with a chronic condition rather than focusing efforts on high-utilizing individuals may be effective in improving quality but may not reduce costs. Error reduction has great potential to improve quality while reducing costs, although the probable cost reduction is a small portion of national health care expenditures. Access to primary care has been shown to correlate with reduced hospital use while preserving quality. Inappropriate care and overuse of new technologies can be reduced through shared decision-making between well-informed physicians and patients. Physicians have a central role to play in fostering these quality-enhancing strategies that can help to slow the growth of health care expenditures.

Author and Article Information

From the University of California, San Francisco, San Francisco, California.

Potential Financial Conflicts of Interest: None disclosed.

Requests for Single Reprints: Thomas Bodenheimer, MD, Department of Family and Community Medicine, University of California, San Francisco, Building 80-83, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110; e-mail, tbodenheimer{at}medsch.ucsf.edu.

Current Author Addresses: Dr. Bodenheimer: Department of Family and Community Medicine, University of California, San Francisco, Building 80-83, San Francisco General Hospital, 1001 Potrero Avenue, San Francisco, CA 94110.

Dr. Fernandez: Division of General Internal Medicine, University of California, San Francisco, San Francisco General Hospital, Ward 13, Building 10, 1001 Potrero Avenue, San Francisco, CA 94110.

Read all Rapid Responses

Values driving healthcare costs

William L. Berger

Annals Online, 25 Jul 2005 [Full text]