The Importance of Quality

It is difficult to have a free market if consumers lack information about both pricing and quality. Unfortunately, for a long time, the US healthcare industry has lacked both pricing and quality information. Very slowly, pricing information is becoming more available. Information on quality metrics, however, has been lacking. For example, it would be nice to know the mortality rate and complication rate associated with a specific surgeon. KFF Health News published a piece about one man's quest to address a quality metric at the hospital level. His wife passed away while in an intensive care unit, even though the medical staff believed she was healthy enough that she would soon be discharged. The husband believes that the hospital had inadequate nursing staffing levels to stabilize her condition when it deteriorated.

The husband's proposed solution is for the state government to mandate nursing staffing levels to ensure that hospitals have enough nurses for their patients. Both the hospital industry and nursing unions appear to agree that there is a shortage of nursing staff employed by hospitals. However, nursing unions seem to blame hospitals' cost-cutting measures, which includes inadequate staffing levels, leading to burnout. The article points out that hospitals do not get paid for nurses, whereas they do get paid for procedures that are done by physicians.

The husband is quoted as believing the proposed legislation to mandate nursing staffing levels would save lives. The legislation would indeed probably result in better patient care and saved lives. However, the costs are unclear. Beyond the financial costs that hospitals would have to bear for increased staffing (costs that they will likely pass on to insurers), there is also a cost in terms of hospitals that would close wards rather than operate them at the higher cost to be in compliance with the new legislation. The reduced access could mean that while the legislation could save lives in some hospitals, it could also cost lives elsewhere. That is likely an empirical question for academics to weigh in on. In the meantime, it would at least be nice for more statistics about the quality of care (including patient survival rates) to be published for both academics and the public to see.