Major issues in the Institute of Medicine

Healthgrades Report:

Hospital quality and mortality rates

People often have relatively little choice in selecting what particular hospital they must have a procedure performed at or where to go to the ER. But "the assumption that the nearest hospital is as good a choice as any other is a risky one" according to the American Hospital Quality Outcomes 2014: Healthgrades Report to the Nation (Healthgrades, 2014: 3). Uneven quality of care is a serious problem for healthcare institutions. In a study of Atlanta hospitals, a stroke patient's risk of dying is 17 times higher if they go to one hospital vs. another with a lower rate. In a study of hospitals overall, patients have a significantly higher risk of dying if they go to a one-star rated hospital vs. A five-star hospital. For a heart attack there was a 48.1% lower risk (11.0% vs. 5.7%) going to a higher-quality hospital; for COPD there was a 81% lower risk (Healthgrades, 2014:3-4).

Healthcare consumers are often operating with extreme asymmetries of information: they must assume their provider knows how to do what is right for them. They must trust their doctor or nurse to tell them if a procedure is necessary and if it is performed correctly. Although they can do research and exercise some due diligence in their selection of who performs procedures, insurance restrictions often limit their choice on a personal level and limits the ability of the free market to ensure that the best providers receive the most business. "Ultimately, the insurance plan you pick dictates the doctors you can see, the hospitals you can use, and has the ability to directly influence the outcome and cost of your care" (Healthgrades, 2014:1). Cost and/or employer can influence choice of insurance providers as well. Thus uniformity of quality of care is something all hospitals must aspire to on a daily basis.

It is essential that appropriate quality controls become more universally embraced so consumers do not feel as if they are risking their lives based upon entering a hospital. They must not be faced with an unknown quantity in terms of the care they will receive. And high mortality rates and complications obviously are serious from a self-interested consumer's perspective but they also are challenging based upon a cost-focused standpoint. Costs to the healthcare system increase notably when quality is low given that this leads to return visits and additional procedures. The cost of a hip surgery with complications and a patient who dies during the hospital stay is almost twice as much as a complication-free surgery (Healthgrades, 2014: 7). And this does not even begin to take into consideration the additional legal costs which ensue with complications due to surgery.