3 ms·

What if the cheaper place is cheaper cause it's not as capable? How am I supposed to know? In what other scenario are we similarly encouraged to act on price al

What if the cheaper place is cheaper cause it's not as capable? How am I supposed to know? In what other scenario are we similarly encouraged to act on price alone? Price transparency is meaningless with quality transparency.

henrikschroder 8y ago
Measuring quality is also incredibly difficult, patient input is practically worthless. Every time patients are asked to rate the quality of the care, they consistently rate simple feel-good care like massages, chiropractice, or just therapy as very good, but saved-your-lfe-operations get rated very badly, because the experience and recovery is often miserable. You live, but you don't feel good, so you rate the quality of the care after how you feel, even though you ought to rate it Five-star, A++++, would transplant a failed heart again! So the rational person abandons subjective ratings and look at objective ratings, what's the medical outcome for a provider? Sure, that's better, but the quality of the outcome is incredibly dependent on the quality of the patients! It's a well-known fact that a positive attitude helps immensely with recovery, how do you measure that? How do you integrate that with an outcome measurement?
conanbatt 8y ago
Price is the best mechanism for organically assessing quality at scale.
dv_dt 8y ago
And quality transparency isn't that much help either - if you have cancer are you really going to shop around if chemo treatment drug group A is more effective then drug group B? A patient cant even begin to be able to shop around for something like that.
tialaramex 8y ago
... and assessing quality in this space is way outside of what a normal consumer is capable of anyway. The UK has periodically had a back and forth on whether the outcome ratio numbers which are collected for internal statistical measures should be published. ie should we make it easy to get a number that says 4.6 for Mr Able, 5.2 for Ms Awesome and 3.8 for Mr Good? At one extreme the reality may be that Mr Good isn't good and his numbers are low because he's a bad surgeon, he makes a lot of mistakes, his technique is not what it should be, he's using an approach that's outdated... that's a real problem, and maybe "patient choice" is a fix where colleagues may be reluctant to say "Fire Mr Good" because he's a good guy, he's not _terrible_ at his job, but yeah they would not themselves choose to be treated by him. At the other extreme the reality may be that Mr Good is the only guy who'll take patients that Ms Awesome thinks are too high risk. She thinks it's better to say "No", he thinks if they seek medicine he should do his part. Maybe they're obese, or they won't stop smoking, or they won't stop doing the sport that's wrecking their body. And Ms Awesome is right that Mr Good's patients are higher risk, but that's not because he's doing a bad job, he's playing what was dealt.
- dsfyu404ed 8y ago
  Also don't forget that Mr. Good might have tougher customers because he's Mr. Good and his prices are low or because he's willing to take on the hardest jobs that are unlikely to leave customers satisfied no matter how good they turn out. If you're the guy that everyone goes to because nobody else is willing to try and fix what you will your success/failure ratio will by abysmal.

henrikschroder 8y ago

Measuring quality is also incredibly difficult, patient input is practically worthless. Every time patients are asked to rate the quality of the care, they consistently rate simple feel-good care like massages, chiropractice, or just therapy as very good, but saved-your-lfe-operations get rated very badly, because the experience and recovery is often miserable. You live, but you don't feel good, so you rate the quality of the care after how you feel, even though you ought to rate it Five-star, A++++, would transplant a failed heart again! So the rational person abandons subjective ratings and look at objective ratings, what's the medical outcome for a provider? Sure, that's better, but the quality of the outcome is incredibly dependent on the quality of the patients! It's a well-known fact that a positive attitude helps immensely with recovery, how do you measure that? How do you integrate that with an outcome measurement?

conanbatt 8y ago

Price is the best mechanism for organically assessing quality at scale.

dv_dt 8y ago

And quality transparency isn't that much help either - if you have cancer are you really going to shop around if chemo treatment drug group A is more effective then drug group B? A patient cant even begin to be able to shop around for something like that.

tialaramex 8y ago

... and assessing quality in this space is way outside of what a normal consumer is capable of anyway. The UK has periodically had a back and forth on whether the outcome ratio numbers which are collected for internal statistical measures should be published. ie should we make it easy to get a number that says 4.6 for Mr Able, 5.2 for Ms Awesome and 3.8 for Mr Good? At one extreme the reality may be that Mr Good isn't good and his numbers are low because he's a bad surgeon, he makes a lot of mistakes, his technique is not what it should be, he's using an approach that's outdated... that's a real problem, and maybe "patient choice" is a fix where colleagues may be reluctant to say "Fire Mr Good" because he's a good guy, he's not _terrible_ at his job, but yeah they would not themselves choose to be treated by him. At the other extreme the reality may be that Mr Good is the only guy who'll take patients that Ms Awesome thinks are too high risk. She thinks it's better to say "No", he thinks if they seek medicine he should do his part. Maybe they're obese, or they won't stop smoking, or they won't stop doing the sport that's wrecking their body. And Ms Awesome is right that Mr Good's patients are higher risk, but that's not because he's doing a bad job, he's playing what was dealt.

dsfyu404ed 8y ago
Also don't forget that Mr. Good might have tougher customers because he's Mr. Good and his prices are low or because he's willing to take on the hardest jobs that are unlikely to leave customers satisfied no matter how good they turn out. If you're the guy that everyone goes to because nobody else is willing to try and fix what you will your success/failure ratio will by abysmal.