When I was operating employee health plans I would frequently have “discussions” with employees when their doctor (almost always out of network) charged far more than the plan allowed as a reasonable and customary fee. Generally I would hear that the doctor was the “best” that’s why he charged more or “he saved my life, I don’t care what it cost” … until a large portion of the fee was out of pocket. I have no doubt that many patients equate high quality health care with high cost. After all, that is generally true when we purchase many goods and services.
However a new study by health researchers concludes that the link between high cost and high quality health care remains unclear with inconsistent findings. The report of study results notes:
Of the 61 studies that met the inclusion criteria [in the overall study], higher cost was associated with better quality of care in 21 (34%), indicating a positive or mixed-positive association between the 2. In 18 studies (30%), the association was negative or mixed negative (lower cost was associated with higher quality), and in 22 studies (36%), the association was nonexistent, mixed, imprecise, or indeterminate.
We tend to transfer our beliefs and every day assumptions about purchases to health care. But health care is far more complex, more imprecise and highly emotional to do that accurately.
More money spent on health care, indeed simply providing more health care is not automatically more efficient or beneficial. We must continue to work toward the worthy goal of a balance between what we spend on health care, what we can afford to spend and the value received. Health care providers and insurance companies cannot find that balance without patient involvement in the process.
QUINNSCOMMENTARY 
The low cost high quality areas of the country have really been noticed by US policy makers. The obvious conclusion they draw is payment can be at the low end of the scale and a quality product can emerge. Although, that conclusion has been reached in many other countries. In Japan where doctors have the lowest salaries of industrialized countries they do provide good care (some get extra income by owining the parking garage next to their offices!). French doctors rebelled at the fees they were to be paid under the French health system — they were told there was no other option and they caved — French health care is actually pretty good now.
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There are islands of high quality low cost care in this country. For example, Cedar Rapids Iowa, Temple Texas and Everett Washington to name a few. The organizations in those communities have focused on quality and accepted lower reimbursement. The less money health care takes out of a local economy the more is left over for things like education, the arts and infrastructure. This is not rocket science!
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Very true, but what is the motivation for providers to accept lower reimbursement? Saving money by being more efficient means someone is earning less.
Dick
Richard D Quinn Editor Quinnscommentary.com
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Motivation to acccept lower reimbursement? None at all. In Iowa there is a very large elderly population thus Medicare is a dominant payor. Iowa doctors are just paid less (49th on the federal schedule) — you take what is paid and try to do a good job. There is a strong farm ethic in Iowa. Elsewhere in the US where you find high quality it is not happening by accident — there is usually a culture of quality — something that is hard to copy.
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Unfortunately you can’t transfer an Iowa ethic to other parts of the country and with a dominate Medicare population they don’t have much choice in their reimbursement.
Dick
Richard D Quinn Editor
http://www.quinnscommentary.com
Health Insurance Illuminated http://blog.horizonblue.com/
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Don’t always agree with the theory that paying more you get better quality, service, etc. You can buy a high price car and still get a “lemon”. Same goes for a doctor. Also a “good” doctor is really in the eyes of the person receiving the service. Some folks are more critical than others. I feel that my doctor is very good and his compensation is reasonable, but if a problem occurs during service, is that because I didn’t pay for a more expensive doctor. I don’t believe so. I would rather check his credentials rather than how much he is paid.
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