Sunday, November 14, 2010

Prove it!

A well regarded local hospital administrator last week said, "There is lots of evidence that Massachusetts health care is the best in the country." The context was a discussion in which it was pointed out that health care costs in Massachusetts are above the national average, even adjusted for wage differences. The statement was made to suggest that it is worth paying a bit more if what we actually get is better.

I was taken aback. I have never seen any evidence to support this conclusion. Would anyone care to offer quantitative support for the proposition -- or against it?

10 comments:

Steve said...

http://en.wikipedia.org/wiki/List_of_U.S._states_by_life_expectancy

We're number 5 in the most important health care statistic.

Paul Levy said...

Is that health care, or life style? If you take that chart and correlate with obesity, is there a connection? Ditto for education levels?

Steve said...

That is a good question, and I don't know the answer. Although I can also send you a link showing North Dakota and Hawaii as having both higher obesity rates and lower household incomes than Massachusetts, so I suspect it's more complex than just those two factors.
I would add that I don't really know whether health care is better in Massachusetts. I also don't know that it's not. But - as someone who was born with a pre-existing condition (a BAD aortic valve, fixed twice by outstanding docs at YOUR hospital - Ralph De La Torre in 2001 and Kamal Khabbaz last year - to whom my family and I will be eternally grateful) I am equally willing to consider a higher cost of health care as worthwhile if we can insure all, rather than just the wealthy and healthy. A socialist sentiment indeed, but one I completely comfortable with.

Barry Carol said...

I don’t know a about Massachusetts, but I think people, including many Republicans in Congress, who suggest that U.S. healthcare is the best in the world are probably referring to what Don Berwick calls “rescue care.” This includes procedures like organ transplants, heart surgery and advanced cancer treatments for which wealthy foreigners often travel here for treatment and are prepared to pay full list price for it.

Issues like primary care, use of electronic records, care coordination between PCP’s and specialists and the problem of the uninsured are different matters entirely. I’ve heard Berwick say that we probably are the best at rescue care but there is huge waste throughout our system due to everything from the fee for service payment model to defensive medicine to perceived patient expectations.

I think we might be able to attack this waste by extending what’s called value based insurance design to high cost treatments including advanced imaging, medical devices, cancer treatment and expensive surgeries. Hospitals that charge more because of their market power without offering superior quality vs. their competitors would see patients subject to much higher coinsurance if they insist on going to the high cost facility. In the most recent issue of Health Affairs (subscription required), James Robinson has an excellent article on this topic.

Jim Conway said...

Paul, nothing I’d like more but the data hasn’t yet proven it out. It is within our horizon.

The MA Health Care Quality and Cost Council has a 2012 goal that we would be first among the 50 states.

Hope this data below helps.
Jim Conway QCC and IHI

Commonwealth Fund State Scorecard has MA 7th in the nation. http://www.commonwealthfund.org/Maps-and-Data/State-Scorecard-2009/DataByState/State.aspx?state=MA

In the Commonwealth Fund Child Health Score Card has us 4th in the nation. http://www.commonwealthfund.org/Content/Publications/Fund-Reports/2008/May/U-S--Variations-in-Child-Health-System-Performance--A-State-Scorecard.aspx

AHRQ has MA on the edge of average to strong. http://statesnapshots.ahrq.gov/snaps09/dashboard.jsp?menuId=4&state=MA&level=0

CAPC has us getting a C in palliative care. http://www.capc.org/reportcard/home/MA/RC/Massachusetts

YM said...

I think that your question is a good and important one. I do not have data.

I would argue that Massachusetts might have had the best healthcare before the universal coverage and the question is has it improved since the change and was the change in cost worth it.

I think that this brings another important question which is how do you measure the quality of healthcare.

Is it life expectancy?

Is it the number of medical errors per procedures performed?

Is it the recurrence of a disease or hospitalization/emergency department visits?

Is it the percentage of people with chronic diseases in age groups?

I know that CMS began measuring some parameters but it is time for hospitals and states to start measuring so they can track trends and evaluate providers and the overall level of healthcare in each state and city – the same way school systems are valued.

John Morrow said...

The 2008 data for CMS Region I was fairly compelling showing CMS-I as the Best in Value when incorporating: quality, safety, satisfaction, cost/effieciency, price (market basket), 30-day re-admission and 30-day mortality rates. BUT, that dropped off in 2009 when Region I moved to the bottom of the list Nationally. There is nothing inherent in the Massachusetts State border that makes this discussion more or less meaningful, as in the State there is good and bad care.
Like much of history, reputation trails prerformance, so in 2008 CMS Region-I had something to talk about, but not in 2009!
The Ratings Guy

Scot said...

From Facebook:

At http://statesnapshots.ahrq.gov/snaps09/dashboard.jsp?menuId=4&state=MA&level=0 there are AHRQ graphs show that Mass. comes out overall at the boundary of "average" and "strong" compared to all states. WI, MN, and a few others are slightly better. Many other states are worse. "The best?" Not by this measure. Pretty good? Yes. Worth the cost? Per capita, MA is up there in costs per chart at http://www.statehealthfacts.org/comparemaptable.jsp?cat=5&ind=596 and http://www.chrt.org/assets/price-of-care/issue-brief-1-images/figure-1-big.png .

p.s. the above is a limited search. Paul, I ran the science research library at Merck Research Labs and had a team of information science/search experts who used to perform comprehensive world literature searches to answer questions like this (and much more complex scientific questions as well). For a definitive answer, ask a librarian!

Anonymous said...

The AHRQ data from the commenter above, containing more traditional quality measures, are interesting and not so rosy, noting a performance decline on 'hospital measures' from high average to average. This is seemingly driven by a worsening of patient safety performance relating to inpatient sepsis (probably central line infections).

Note that the data, particularly for the sepsis figures, are out of date. This is a strong argument for your oft-repeated call to publish these data in real time, Paul - so we can tell if this trend continued or improved beyond 2006. Hopefully, BIDMC's strong performance in this regard has pulled up the state's results with it.

nonlocal

jonmcrawford said...

Have to say I was dissapointed that the first link posted was from Wikipedia, but others have more resources, so that's good. Found this one that actually shows Obesity (look at the very bottom of the page) with MA ranked at 48, so that's a good ranking, but not a lot of data there for that particular metric.

http://www.worldlifeexpectancy.com/usa/massachusetts-health-profile

Interesting discussion.