Health Care Reform Is on the Way: Do We Want To Compete on Quality?

Editorials1 January 1994Health Care Reform Is on the Way: Do We Want To Compete on Quality?Robert H. Brook, MD, ScDRobert H. Brook, MD, ScDRAND Corporation, Santa Monica, CA 90407-2138.Author, Article, and Disclosure Informationhttps://doi.org/10.7326/0003-4819-120-1-199401010-00015 SectionsAboutFull TextPDF ToolsAdd to favoritesDownload CitationsTrack CitationsPermissions ShareFacebookTwitterLinkedInRedditEmail Conversations about health care reform, even those involving physicians, usually focus on cost and access: Should there be a single-payer system? How will managed competition save money? Should patients pay a large deductible or have co-insurance? Will dental and mental care be part of the basic benefit plan? It is strange that these conversations ignore how clinical practice should be altered.In this issue of Annals [1], Topol and Califf endorse a fundamental clinical change involving the release of physician-specific information about performance. In particular, do the patients of physician A do better, after controlling for sickness, than those of ...References1. Topol EJ, Califf RM. Scorecard cardiovascular medicine: its impact and future directions. Ann Intern Med. 1994; 120:65-70. Google Scholar2. Brook RH, McGlynn EA. Maintaining quality of care. In: Ginzberg E, ed. Health Services Research: Key to Health Policy. Cambridge: Harvard University Press; 1991:284-314. Google Scholar3. Brook RH. Maintaining hospital quality: the need for international cooperation. JAMA. 1993; 270:985-7. Google Scholar4. Nightingale F. Mortality of the British army at home and abroad and during the Russian war as compared with the mortality of the civil population in England. Reprinted from: Report of the Commission Appointed to Inquire Into the Regulations Affecting the Sanitary State of the Army. London, England: Harrison and Sons; 1858. Google Scholar5. Pennsylvania Health Care Cost Containment Council. A Consumer Guide to Coronary Artery Bypass Graft Surgery. Harrisburg: Pennsylvania Health Care Cost Containment Council; November 1992. Google Scholar6. New York State Department of Health. Coronary Artery Bypass Graft Surgery in New York State: 1989-1991. Albany: New York State Dept of Health; 1992. Google Scholar7. Williams SV, Nash DB, Goldfarb N. Differences in mortality from coronary artery bypass graft surgery at five teaching hospitals. JAMA. 1991; 266:810-5. Google Scholar8. Efron B, Morris C. Stein's paradox in statistics. Sci Am. 1977; (May):119-28. Google Scholar9. Hannan EL, Kilburn H Jr, O'Donnell JF, Lukacik G, Shields EP. Adult open heart surgery in New York State: an analysis of risk factors and hospital mortality rates. JAMA. 1990; 264:2768-74. Google Scholar10. Hannan EL, Kilburn H Jr, Bernard H, O'Donnell JF, Lukacik G, Shields EP. Coronary artery bypass surgery: the relationship between in-hospital mortality rate and surgical volume after controlling for clinical risk factors. Med Care. 1991; 29:1094-107. Google Scholar Author, Article, and Disclosure InformationAffiliations: RAND Corporation, Santa Monica, CA 90407-2138.Corresponding Author: Robert H. Brook, MD, ScD, RAND, 1700 Main Street, P.O. Box 2138, Santa Monica, CA 90407-2138. PreviousarticleNextarticle Advertisement FiguresReferencesRelatedDetailsSee AlsoScorecard Cardiovascular Medicine: Its Impact and Future Directions Eric J. Topol and Robert M. 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Koniaris, MDThe effectiveness of the public release of performance data in changing consumer, healthcare professional or organisational behaviour.Development of a Risk-Adjusted Urinary Incontinence Outcome Measure of Quality for Nursing HomesComparing outcomes of coronary artery bypass surgery: Is the New York Cardiac Surgery Reporting System model sensitive to changes in case mix?The Impact of Quality Report Cards on Choice of Physicians, Hospitals, and HMOs: A Midcourse EvaluationInsurance and Inpatient Utilization for HIVWhat Patients Should Ask of Consumers' Guides to Health Care QualityQuality of Care Information Makes a DifferenceHow Pennsylvania Hospitals Have Responded to Publicly Released Reports on Coronary Artery Bypass Graft SurgerySeries on the Quality of Health CareDo Cardiologists Do It Better?Influence of Cardiac-Surgery Performance Reports on Referral Practices and Access to Care — A Survey of Cardiovascular SpecialistsWhat will be the outcome of the outcomes movement?Report Cards on Cardiac Surgeons — Assessing New York State's ApproachPresidential address: Outcome assessment in vascular surgery — Results mean everythingCleveland Health Quality Choice: A Model for Collaborative Community-Based Outcomes Assessment 1 January 1994Volume 120, Issue 1Page: 84-86KeywordsCardiovascular proceduresCoronary arteriesForecastingHealth careHealth care qualityMortalityPublic policyQuality of lifeSurgeonsSurgery Issue Published: 1 January 1994 Copyright & PermissionsCopyright © 1994 by American College of Physicians. 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