How Much Are We Willing To Pay for Information about Quality of Care

Once we agree-or concede-that intense, unscripted competition is now “reforming” the U.S. health care system, the pressing need for information becomes self-evident. Few sentient beings would argue the first point. In some areas, competition has rocked and upended health care landscapes that formerly shifted only with the grinding reluctance of tectonic plates. The second point follows: Information is necessary for making informed choices among competitors. To date, however, costs have been easier to quantify than quality, so dollars have dominated decision making.

When driven purely by price, competition is antithetical to the fundamental mission of health care. Information, therefore, is also essential to ensure that quality enters the competitive equation. The rhetoric of leading health care competitors asserts their interest in “value,” an amalgam of cost and quality. Nonetheless, explicit quantification of value remains elusive. Experts legitimately claim that rigorous measurement of health care quality is now possible [1, 2]. However, obtaining good information about anything-such as putative health care quality-requires money and time. Designing meaningful quality measures and measurement tools, obtaining necessary data from medical records or patients, ensuring minimal reliability and accuracy of data, doing credible statistical analyses, and other necessary tasks are expensive and time-consuming. How much are we willing to pay to learn about health care quality?

Thus far, most U.S. initiatives to examine hospital quality have begun on a small scale, using readily available, computer-readable hospital discharge abstracts to examine mortality rates [3, 4]. Discharge abstracts, typically produced through hospital billing, include such items as patient demographic characteristics, payer, dates, discharge disposition, and …