Hospital Quality
Via Tyler Cowen, a paper on consumer-driven health care in action:
Amenities such as good food, attentive staff, and pleasant surroundings may play an important role in hospital demand. We use a marketing survey to measure amenities at hospitals in greater Los Angeles and analyze the choice behavior of Medicare pneumonia patients in this market. We find that the mean valuation of amenities is positive and substantial. From the patient perspective, hospital quality therefore embodies amenities as well as clinical quality. We also find that a one-standard-deviation increase in amenities raises a hospital’s demand by 38.4% on average, whereas demand is substantially less responsive to clinical quality as measured by pneumonia mortality. These findings imply that hospitals may have an incentive to compete in amenities, with potentially important implications for welfare.
This is irrational on one level. But on the other hand, it’s pretty intuitive — people are much better equipped to judge the quality of hospital amenities than they are to judge the quality of patient care. I’m also familiar with research indicating that when it comes to malpractice suits the main issue isn’t how much the doctor screws up, but whether or not he or she is a generally nice and friendly person. Again, you can see why it might go that way, but these things are important aspects of the health care market.
32 Responses to “Hospital Quality”
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January 3rd, 2009 at 5:10 pm
It’s also the reason so many Americans are suspicious of copying the health care of other nations — they tend to focus on “care” to the point of filthy bedrooms, cold staff, and generally bad experiences being made unbearable.
January 3rd, 2009 at 5:20 pm
What about the power of the consumer? Why can’t I shop around for the best hospital? Oh yeah, because life is short, I’m completely incapable of the task, and I’d probably just pick the hospital with the least bad smell and the best selection of cable channels in the patient rooms. So I’d rather have Daschle’s Federal Health Board measuring health care outcomes.
January 3rd, 2009 at 5:23 pm
Having recently experienced ER care in a Jersey City hospital and a week later minor surgery (with total anesthesia) in one in Bayonne, I can say with certainty that “amenities” such as responding to reasonable requests, pleasant demeanor from the nurses, and honest answers to questions meant a great deal to me, both with their absence (Jersey) and presence (Bayonne). Details are not necessary.
Of course I realize that ER staffs are overworked and understaffed, but when I was admitted after a 911 call, dehydrated and very weak from a violent stomach flu, bleeding from having passed out in my bathroom and fallen on my face into the bathtub, I was in little condition to be understanding. Luckily the breaking of my nose was not serious — no fragments, no breathing obstruction, no arterial damage. Still, the Xray didn’t happen until I had been there four hours, and if it had been serious we wouldn’t have known it until then…plenty of time for serious consequences. And being required by the X-Ray tech to hold motionless positions even after he had pushed the button, while weak as a new-born, was not fun. He couldn’t seem to get it when I asked him to tell me when I could relax, as if that was just too bad for me. As simple a matter as an IV stand on wheels (so I could limp to the john and spare my room-mates the sound of my heaving) was not to be had, nor a decent blanket — since I was shaking with chills — until the fourth or so request. Although the doctor wanted to keep me overnight, I signed myself out and took a cab home, since at that point what I needed more than anything else was sleep, and there was none to be had in that place.
If these little things be amenities, then I can certainly agree that I will always prefer Bayonne Medical Center if it is necessary, to the other place.
January 3rd, 2009 at 6:41 pm
What’s stunning is the lack of interest in cost and the relative disinterest in outcomes. I understand that markets don’t work in health care, but I also understand that our non system of care is failing in part because we can’t/won’t address our costs and inefficiency.
We’re going bankrupt and we’re concerned with amenities. There’s something wrong with this picture!
http://www.medicynic.com
January 3rd, 2009 at 6:47 pm
they tend to focus on “care” to the point of filthy bedrooms, cold staff, and generally bad experiences being made unbearable.
ITYM ‘they don’t spend thousands of dollars on country-club style leather armchairs in reception’. The flip-side is that foreigners think that American hospitals focus on superficial shit ($5m in travel insurance health coverage, anyone?) while millions don’t get through the door.
From experience, for the bits that aren’t ‘consumer-facing’, American hospitals look no different from ones in other developed nations. If anything, the staff amenities get squeezed more to ensure that the superficial front-office stuff resembles a hotel lobby. All of which is to say that there’s a difference between “reasonable requests, pleasant demeanor from the nurses, and honest answers to questions” and touting your hospital’s spa facilities and Wolfgang Puck menu.
January 3rd, 2009 at 7:01 pm
Some years back, the people treating childhood leukemia at one of the main hospital in this state (New Mexico) decided to stop adopting improvements – improvements that had raised the survival rate from ~50% to something like 80% every else. As far as I can understand, the doctor in charge of the program just didn’t like the new drug regimens. So quite a few kids died. There were no complaints from the parents of those kids, because none of them knew enough to realize what was going on.
I would have noticed, if one of my kids had been involved, but judging from results, not 1 in 100 people know enough (in New Mexico, anyhow). Few even try to find out.
January 3rd, 2009 at 7:05 pm
We had one child in Canada, one child in the US. The “amenities” are indeed much better in the US. All sorts of hotel like treatment. The staff wasn’t any friendlier, and the proved to be less competent. When my wife wanted to leave after the second day, as she prefers to recover at home, they did their best to block it, and could not offer a medical reason. Finally, the doctor smiled and said, “Ma’am you must let us make our money.”
January 4th, 2009 at 12:32 am
OK, so does Yglesias not know the meaning of the term “consumer-driven health care”, or is he just being dishonest? The idea of CDHC is that by passing on more of the cost of health care to patients you should make them into more efficient consumers. This study uses Medicare patients, i.e. patients who do not share in much if any of the cost of care and thus have very little incentive to make cost-effective decisions. Of course patients who do not bear the additional cost will choose the fancier hospital, all else being equal.
There are interesting things to learn from this study, but it says nothing about “consumer-driven health care”. The authors even admit as much when they say:
“In addition, we need not measure, nor deal with
the endogeneity of, their out-of-pocket costs, because these costs are uniform across hospitals.” For this to have any relevance to the point Matt wanted to make you would need a population of patients who bear the additional cost of the amenities the hospital provides.
January 4th, 2009 at 8:21 am
I must agree with jrosen here. I spent way too much time in hospitals both as a patient and as a husband to my late wife. The amenities make it possible for a family to support someone in the hospital with a much lower stress level. A comfortable lounge and reasonable food and coffee are, for the loved one of a patient, huge.
For the patient it matters too: the quality of food for a patient. Believe me Matt, it’s hard enough to eat on chemo. Being able to pick up a decent lunch during an all-day session matters.
January 4th, 2009 at 10:47 am
“Amenities” might mean the difference between two wings, a new one and an old one, my husband stayed in in one hospital in Tallahassee Florida last year. In the old room, the intercom blared all night. It couldn’t be turned down or off. It was there so a staff member in his room would know if they were needed somewhere else. In the new room there was no intercom for hospital staff. They carried their phones or beepers with them. It was the difference between being jolted awake every two minutes or sleeping.
January 4th, 2009 at 12:36 pm
In general “amenities” is the consumer’s best indication of how much money the hospital has to throw around. A dirty hospital with leaking ceilings doesn’t necessarily indicate bad care, but it seems a valid warning sign.
Now, of course, once hospitals realize this, they can easily game the system. Drywall is relatively cheap compared to doctor salaries and medical equipment…
January 5th, 2009 at 1:14 pm
Amenities is basic need of a hospital. Health care policies should be made in a such manner to handle all issues of a hospital including amenities. http://www.medicaremontana.com.com
January 5th, 2009 at 3:25 pm
Unfortunately, even the NHS is not immune to the ‘international hotel lobby’ school of makeover. We have a whole series of privately financed, but state owned hospitals (PFI’s), whose initial ‘wow’ factor may impress politicians, but the actual level of service and amenities have often fallen far short of their older and less glamorous NHS built counterparts.
Its nice to have a new building, and certainly a decent meal and a smile go a long way to help someone’s stay in hospital, but having worked in a hospital, giving the best possible care to a patient and their family should not be confused with the look or style of a place.
Remember, if the managers spent all that money on reception, what did they not spend that money on?
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