Inconsistent relationship exists between health care quality, cost

As the debate on cutting health care spending continues in the United States, its association with health care quality remains controversial. In a systematic review published in the Annals of Internal Medicine, researchers aimed to understand this relationship.

Researcher Peter S. Hussey, PhD, policy researcher at the RAND Corporation and a professor at the Pardee RAND Graduate School in Santa Monica, Calif., and colleagues reviewed literature from PubMed, EconLit and Embase databases ranging from 1990 to 2012.

After including 61 studies, the researchers wrote that 21 (34%) demonstrated a positive or mixed-positive association; 18 (30%) reported a negative or mixed-negative association; and 22 (36%) had no difference.

In an instrumental variable analysis, they also found that seven of nine studies showed a positive association. However, other characteristics or limitations could have affected these findings, they wrote.

Although many studies have suggested a link between cost and quality, Hussey and colleagues ultimately found it to be inconsistent.

In an accompanying editorial, Alyna T. Chien, MD, MS, of Harvard Medical School and Boston Children’s Hospital, and Meredith B. Rosenthal, PhD, of Harvard School of Public Health, wrote that detailed and timely data are needed for better decision-making that affects clinical and fiscal outcomes.

“First, physicians need to begin having some understanding of the costs of the services they provide and their potential relationship to care quality,” Chien and Rosenthal wrote. “This can be achieved if provider organizations are more transparent about the cost and price of the services they deliver and if physicians become more active about acquiring this information.”

They said those who fund research should also support studies that have a goal of evaluating the cost-effectiveness of both clinical and quality interventions.

Additionally, it is important for payers to weigh the financial risk vs. benefit when applying pay-for-performance incentives, and targeted incentives should be offered to discourage poor service, Chien and Rosenthal said.

Hussey and colleagues said further studies should look at the type of spending that is most effective for quality improvements, as well as the type that is simply wasteful.

For more information:

Chien AT. Ann Intern Med. 2013;158:67-68.

Hussey PS. Ann Intern Med. 2013;158:27-34.

Disclosure: Hussey reports funding to his institution by various entities for grant and contract support for health services research on health care cost and quality issues, including Robert Wood Johnson Foundation, with other grants pending.