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How good is your healthcare?

Ano Lobb | Friday 6th November 2009

Or doctor? Or hospital? Chances are, if you are satisfied with the outcome, you'd say the care was good. If you've had bad experiences then your review would be less positive. Regardless, you probably have little information to evaluate the quality of the healthcare you receive, the doctors providing it, or the hospitals housing them.

How is the quality of healthcare evaluated? On the national level, you can look at key health indicators like life expectancy and under-5 infant mortality. Live in Switzerland or Costa Rica? Life expectancy is around 82 or 79 years, and the under-5 infant mortality rate is 5 and 11 per 1000, respectively. Live in Somalia or South Africa, however, and life expectancy drops to about 53 years, and infant mortality climbs to 154 and 49 per 1000, respectively. Lots of factors contribute to those figures, in themselves they don't tell us what is causing people to thrive or die, and besides moving from Somalia to Costa Rica, they don't help you make health decisions.

National health insurance coverage figures tell us something about ability to pay bills: Only 1% of Taiwanese lack health insurance compared to 20% of Americans under the age of 65. But that doesn't tell us about health or care. Process measures are a good start, and at least in the US these are readily available for hospitals, less so for doctors. These report how often hospitals aredoing important things: Giving aspirin to heart attack patients, for example. They are the types of things that have been shown to improve health outcomes, but they are not outcomes themselves.

There are measures of patient satisfaction: Would you recommend this hospital to a friend? Was it clean, and were your questions answered? It turns out that this is a surprisingly good indicator of quality, since the leading reason for care is poorly coordinated care (providers not communicating with each other or you.)

Ideally we'd like to see outcomes measures, and in some cases we have these. Hospital death rates for heart surgery are available, at least in the US. These can be useful, since death rates are relatively high for such procedures. Mortality is not a good measure for something like hip replacement, another common major surgery with a range of possible outcomes, because death is exceedingly rare. Beyond life and death, we have few outcomes measures for hospitals, fewer for doctors. Then there are safety measures: How many patients contract infections in hospital, for example. The availability and utility of these figures varies. All measures must undergo statistical control to account for the age and health of the patients being seen: You would naturally expect worse outcomes from older and sicker folks, regardless of the quality of care they receive. And there is the "problem of small numbers:" in some cases wide variations in quality are statistically hidden because so few procedures are performed.

What do you want to know about your doctor or hospital?

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