When buying a car, consumers are able to readily review some critical pieces of information, such as the price of the car; the mileage per gallon; what other owners thought of that model’s reliability; and how the car handles on various road tests.
When it comes to health care, however, consumers aren’t able to easily obtain the few, key summative, consumer-facing measures that could help them understand the quality of their care.
This isn’t because we don’t have quality measures in health care. To the contrary — there are in fact hundreds of measures. But these measures tend to be narrow in their scope (for example, management of diabetes or congestive heart failure, or ensuring that a colonoscopy was done for preventive care) making them hard to connect to a broader understanding of quality. The shift to population-based payment in particular has unmasked the gap in “big dot” measures necessary to capture overall system performance.
Production vs. Consumer Measures
In other words, what we have in health care are numerous “production” measures, but very few “consumer” measures. Production measures, in the case of the car, would be the thousands of things the manufacturer needs to know in order to produce a high-quality car: how efficiently and reliably each and every step in the manufacturing process is completed, how much variance there is in the dimensions of a particular part, or the tensile strength of a particular type of steel, for example.
These two sets of measures—production and consumer—both reflect the quality of the product and both are important. However, they tell us fundamentally different things.
While we have hundreds of production measures in health care, we have very little understanding of the measures consumers want and need. This is not particularly surprising, as quality measures tend to be created by people who are (or relate to) producers of health care, rather than the end users.