From the abstract of a new working paper by Harvard Professor David Cutler, “Where Are the Health Care Entrepreneurs? The Failure of Organizational Innovation in Health Care:”
Medical care is characterized by enormous inefficiency. Costs are higher and outcomes worse than almost all analyses of the industry suggest should occur. In other industries characterized by inefficiency, efficient firms expand to take over the market, or new firms enter to eliminate inefficiencies. This has not happened in medical care, however. This paper explores the reasons for this failure of innovation. I identify two factors as being particularly important in organizational stagnation: public insurance programs that are oriented to volume of care and not value, and inadequate information about quality of care. Recent reforms have aspects that bear on these problems.
Here’s a bit more detail from the paper about the orientation of public insurance programs to volume not value:
In most industries, higher quality is associated with higher prices. That is not true in medical care, however, largely because of the public sector. Medicare accounts for 25 percent of physician and hospital services, and Medicaid accounts for another 13 percent. Since the 1960s, Medicare has paid providers on a fee-for-service basis, without reference to the quality of care delivered. Medicaid reimbursements are more flexible, but they are so low that many providers view Medicaid patients as effectively uninsured. As a result, about 40 percent of the market transmits incentives to provide more care but not more efficient care (Medicare) or to avoid patients who are sick (Medicaid). With so much of compensation pegged to volume, not value, inefficient care is the natural outcome.
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With volume emphasized over quality, this indicates a need to incorporate performance metrics into the delivery of health care and also suggests the need for a centralized organization to perform comparative analysis and dictate compensation based on the relative outcomes of individual health providers. Without this, insurers will continue to work the volume strategy and pass along the costs to the policy holders.