ON THE AGENDA | MARCH 21ST, 2016 | DAVID SCHLEIFER, PH.D.

On Health Care Quality, What Does the Public Think?

How do people weigh health care quality when they're faced with a serious situation like joint replacement, diabetes or childbirth?

Experts have a lot to say about measuring quality in health care. But what qualities matter most to patients like you and me?

What do you think makes for a high-quality doctor? When asked this question, most Americans say they focus on doctor-patient relationships and doctors’ personality, according to a 2014 nationally representative survey from the Associated Press-NORC Center for Public Affairs Research.

But do people think differently about quality when they're faced with a potentially more serious situation such as joint replacement, diabetes or childbirth? People facing such situations may be interested in personality and relationships. However, they may also want to choose doctors and hospitals who are “the best.” But the best at what exactly? And according to whom?

We've seen a lot of progress on ratings systems that measure and communicate the quality of care that doctors and hospitals provide. Organizations like the Leapfrog Group, for example, have for many years reported on hospital quality and safety. They have found that a person on Medicare has a one in four chance of experiencing injury, harm or death when admitted to a hospital.

Several other non-profit organizations, private companies and state governments also now publicly rate the quality of hospitals and physician groups. The Centers for Medicare & Medicaid Services recently released core quality measures for treatment in seven areas of health care. These measures are designed to improve consumer decision-making and facilitate value-based payment, among other goals.

But the various ratings systems can actually be quite different in how they rate and report quality. And formal measures of quality may assess aspects of care that are important to regulators and payers but that are too technical for most non-experts—in other words, patients like you and me—to understand.

What types of information do people facing potentially serious health situations say would help them make better choices about doctors and hospitals? How aware are patients that quality can vary from hospital to hospital and from doctor to doctor? Do they feel they have much choice among hospitals and doctors at all?

To answer these and other questions, Public Agenda is working on new research with funding from the Robert Wood Johnson Foundation. Through focus groups and representative surveys, we will be examining how people in three situations—people newly diagnosed with type 2 diabetes, women who have recently given birth and people who have recently had joint replacement surgery—think about quality, price and value. Our survey will address questions such as:

  • What do people who have sought care for diabetes, pregnancy and childbirth, and joint replacement say makes for good quality care?
  • How did they choose their doctors and hospitals? What do they say would have helped them make better choices?
  • What leads people to switch doctors or hospitals in these health care situations?
  • Which “informal” qualities—such as listening skills, respect or convenience—matter to people? How do they weigh these qualities against more “formal” qualities like rates of diabetes complications, rates of readmissions after joint replacement surgery or rates of cesarean sections?
  • Would people be interested in formal quality information if they knew how to find it?
  • How often do people seek price information in these three situations? Are they able to find the price information they want?
  • How do people’s attitudes, decision making, and information needs vary across these three health care situations? How do they vary across demographic groups, insurance status, benefit designs or other personal attributes?

As in our previous research on how adults choose colleges, we may find that many people do not value the qualities that experts see as important. But as in our previous research on how people seek and use health care price information, we might find that even people who have never sought information about formal measures of quality might actually be quite interested in that information, if only they knew how to find it.

Our findings from this research will be available in 2017. To receive the report and to stay informed about our other health care research, please sign up for our email list.


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