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The Quality Cure

The Quality Cure: How Focusing on Health Care Quality Can Save Your Life and Lower Spending Too

David Cutler
Copyright Date: 2014
Edition: 1
Pages: 240
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  • Book Info
    The Quality Cure
    Book Description:

    In the United States, the soaring cost of health care has become an economic drag and a political flashpoint. Moreover, although the country's medical spending is higher than that of any other nation, health outcomes are no better than elsewhere, and in some cases are even worse. InThe Quality Cure,renowned health care economist and former Obama advisor David Cutler offers an accessible and incisive account of the issues and their causes, as well as a road map for the future of health care reform-one that shows how information technology, realigned payment systems, and value-focused organizations together have the power to resolve this seemingly intractable problem and transform the US health care system into one that is affordable, efficient, and effective.

    eISBN: 978-0-520-95776-3
    Subjects: Sociology

Table of Contents

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  1. Front Matter
    (pp. i-vi)
  2. Table of Contents
    (pp. vii-viii)
  3. List of Illustrations
    (pp. ix-xii)
    (pp. xiii-xiv)
    (pp. xv-xviii)
    David Cutler
  6. CHAPTER ONE Cost, Access, and Quality: The Three Horsemen of the Apocalypse
    (pp. 1-15)

    “What do you think are the top two problems with the nation’s medical care system?” In a June 2009 survey, approximately one thousand Americans were asked this question. Over half the respondents cited cost as one of their top two concerns. This mirrors results from April 2007 and March 2008, when the same question was asked to a different group of people, but the same answers were given.¹ Costs appeared in various guises—from concern about prescription drug prices and the high costs of hospital and physician care to overall insurance costs. One way or another, the price tag of...

  7. CHAPTER TWO The Value Proposition
    (pp. 16-35)

    Where does all the medical spending go? The common perception is that high spending involves excessive profits for insurance and pharmaceutical companies, high advertising and marketing expenses, and outlandish pay for health care CEOs. In a survey conducted by the Consumers Union, 76 percent of participants cited pharmaceutical companies as the reasons for high costs, and 77 percent cited insurance companies. Only 59 and 47 percent named hospitals and doctors, respectively.¹

    In this case, people’s perceptions are wrong. Figure 4 shows that pharmaceutical spending in total accounts for only 10 percent of medical spending, and insurance company administrative costs for...

  8. CHAPTER THREE The Cost Control Debate
    (pp. 36-52)

    “Which country has the best health care system in the world?” It’s an easy question to ask but a hard one to answer. Imagine walking into a bar during football season and asking the assembled crowd, “Which team is the best this year?” You would receive a variety of impassioned arguments but probably little agreement.

    Economists are foolish, so they spend a good deal of time debating these questions. In 2000, the World Health Organization ranked France first and England eighteenth. The British were mad. Argentina was ranked above Brazil; Brazil responded by trying to eliminate funding for the World...

  9. CHAPTER FOUR The Quality Cure
    (pp. 53-69)

    Amid the depressing stories about the cost and quality of U.S. health care, there are some distinct outliers. A number of health care organizations across the country have made tangible strides toward higher-quality, lower-cost performance. In this chapter, I describe some of these successes and analyze what we can learn from them about the strategies that lead to good outcomes (see table 6).

    Let’s start off with primary care, which is the backbone of any health system. To see primary care done well, we head to California and Kaiser Permanente. Kaiser Permanente is one of the largest health systems in...

  10. CHAPTER FIVE It’s What You Know
    (pp. 70-95)

    Information is vitally important in health care. When people are ill, the first thing they want from the medical system is information—what is wrong, and what can be done to fix it? Treating physicians need to coordinate information from a variety of sources—textbooks, blood tests, and images, as well as experience—to form a diagnosis. They must then refer the patient to the appropriate follow-up care, based on their knowledge of specialists and the patient’s condition. Specialists must apply their own information sets to determine precise therapies and the sequencing of those therapies. All of this must be...

  11. CHAPTER SIX Pricing the Priceless
    (pp. 96-131)

    “Follow the money,” FBI agent Deep Throat was reported to have toldWashington Postjournalists Bob Woodward and Carl Bernstein as they investigated the Watergate scandal during the Nixon administration. To understand health care, there is no better advice. The way health care is reimbursed has an enormous influence on what is done, and health care reform needs to account for this.¹

    Money does not have the immediacy in health care that other considerations do. When a physician encounters a patient in pain, little else matters until the pain subsides. Instead, money is like the electricity flowing through a house:...

  12. CHAPTER SEVEN Take Me to Your Leader
    (pp. 132-159)

    November 2000 was not a good month for the Obstetrics Department at Beth Israel Deaconess Medical Center in downtown Boston. BIDMC, as it is known, is a major teaching center that delivers about five thousand babies per year. That month, “Suzanne” was admitted to have her labor induced. Suzanne was a married, generally healthy thirty-eight-year-old expecting her first child. She had mildly elevated blood pressure, and her baby was at forty-one weeks gestation.¹ Because of the mild hypertension, Suzanne’s doctor thought induction was the best course.

    Suzanne’s case seemed routine but ended up being tragic. After administration of a labor-inducing...

  13. CHAPTER EIGHT How Long Will It Take?
    (pp. 160-172)

    Focusing on quality has the potential to fix much of what ails American medicine. But how long will the quality cure take? Is it like an antibiotic or a prolonged rehabilitation?

    No one knows the exact answer to this question. Among researchers, there is general agreement that about one-third of medical spending is not necessary. But there is no general agreement on how rapidly that excess can be eliminated. As Yogi Berra said, “Prediction is difficult, especially about the future.”

    Looking across the economy as a whole, there is no one path by which industries go from being less productive...

  14. NOTES
    (pp. 173-200)
  15. INDEX
    (pp. 201-214)