Can Patients Assess Quality Of Health Care?

Does a patient really know what quality is in health care?

I never thought this was a debate (more on my rationale later) until I participated in a discussion on Twitter last week (#solvePT for those who would like to follow and contribute).

It was a tale of contrasting opinions. Some noted that they didn’t think that the patient could adequately define quality of care, and that there had to be some “objective” means of measuring it. Others remarked that quality and value to the patient may in fact be inter-related. It was also noted that even if you provide a patient with effective care defined by evidence-based guidelines, they still might not feel like there was value – even if the problem was resolved!

Health care providers would benefit from looking at other groups that provide services in a market economy. So what happens with other trades or professions that provide services? And how do their customers define quality?

Imagine that you need some work done on your car. You, the consumer, are looking for a service. As a consumer, you make the choice (or not) to do your homework. You might read reviews on that particular auto mechanic or garage, or read materials related to the service being provided, its cost, and reasonable expectations. Consumers make independent choices about auto mechanics in a free and open (and highly competitive) market. The consumer then selects a service that they think will provide them with what they are looking for at the rate at which they are prepared to pay. The consumer then pays for the services rendered by the auto mechanic, and assumes that it will be completed appropriately or as promised. You assess quality and value independent of the auto mechanic.

If you are an auto mechanic, your goal is to create a great customer experience, the best service, or the best price – or all of the above. You want the customer to know why your service is the best available. Does it produce a better outcome? At a lower cost? More time-effectively? You want to meet or exceed the customer’s expectations in order to have high customer satisfaction and brand loyalty.

Oh, and if you are good at what you do, then you will be rewarded with fiscal viability. This is the beauty of a free market economy.

But what happens in the health care world?

The patient is provided a service by a clinician. The patient goes wherever their insurance company (or gatekeeper) tells them they should go in order to have paid benefits. There really isn’t much need for research or review. The clinician doesn’t have any specific need to be accountable to the patient in terms of the patient’s outcome. Why? They are getting paid, regardless of the outcome, whether they use evidence-based guidelines (those that should directly impact clinical quality) or not. The clinician actually makes more money by seeing the patient for more visits and more procedures – counter to the “best service, lowest price” phenomenon found throughout a market economy.

Health care fosters a skewed relationship between clinician and patient from the start.

It begins when patients don’t see a direct relationship between their hard-earned dollars and their outcome. They interpret “more stuff” as “better care”. They  interpret “high tech testing” as better care. That wouldn’t necessarily be the case with their auto repairs, would it?

The skewed relationship goes one step further when clinicians then make the assumption that the patient can’t possibly understand or accurately assess quality. Why do we hold ourselves in such high esteem that we think that the patient can’t define the quality of their own care? Isn’t that a little arrogant? Imagine your auto mechanic telling you that “you just don’t have any idea what quality is – can’t you tell that this work is great work? The car doesn’t drive any better, but I am telling you, it’s great work!”. Of course, the customer wouldn’t accept this blindly.

Let’s face it - people don’t have a gene that gives them the innate ability to establish the quality of their auto repair work. They have to spend the time to learn about auto repair so that they can make informed decisions about how they are going to spend their money. They can listen to many auto mechanics, but ultimately, talk is cheap. Show me the end result. The same should be true in health care. Health care providers, much like auto mechanics in the example above, should be held accountable to the same standards that exist throughout a free market economy.

Health and health care are active processes that require involvement from patients and clinicians alike. Health care isn’t, nor should it be, passive – it is an active process. The easy option is to take the passive approach, the pink pill, to make it all better. Sadly, the passive approach generally promotes dependence and greater expense, not the long-term goals of an effective free market system.

Can patients assess quality of health care? Absolutely. They are more than capable and should in fact be the ones to do so. If the patient chooses to be actively invested in their own health and health care, and clinicians are accountable in the marketplace, then all can function as it should – just like any other service industry. It’s making both of those things take place that is the hard part.

Photo credits: debaird™