1 Quality of Health Care Quality of health care is not a luxury Yaseen Hayajneh, PhD

2 Introduction In USA, Between 8% & 24% of ambulatory patients receive inappropriate or contradicting prescription drugs. Only 34% of patients with hypertension are adequately treated. Quality problems: Overuse Underuse Misuse

3 To Err is Human: Building A Safer Health System A report (1999) by the Committee on the Quality of Health Care in America, Appointed in 1998 to identify strategies for achieving a substantial improvement in the quality of health care delivered to Americans. Focused on a specific quality concern, patient safety. Estimated that 44,000 to 98,000 deaths per year in the U.S. may be due to medical errors. Medical errors in US hospitals might be anywhere from the 5th to the 8th leading cause of death.

4 High-quality Health Care Care that assists healthy people to stay healthy, cures people’s acute illnesses, and allows chronically ill people to live as long and fulfilling a life as possible.

5 Components of High-quality Care 1. Adequate access to care 2. Adequate scientific knowledge 3. Competent health care providers 4. Separation of financial and clinical decisions 5. Organizing HC institutions to maximize quality.

6 1) Adequate Access to Care To receive quality care, people must have access to care. Underuse People with reduced access to care are likely to suffer worse health outcomes… Quality requires equality.

7 2) Adequate Scientific Knowledge SK must exist to distinguish between effective and ineffective care 1960s – estrogen replacement without progestin administration - uterine cancer Evidence based practice

8 3) Competent health care providers In general, Competencies represent clusters of skills, abilities and knowledge needed to perform jobs. A person’s ability to make informed choices and perform work activities to the standards required in the job. Having the skills and knowledge to diagnose problems and choose appropriate treatments.

9 Medical Negligence The failure to meet the standard of practice of an average qualified physician practicing in the same specialty Negligence is not the same as incompetence.

10 4) Separation of financial and clinical decisions The quantity and quality of health care are inextricably (بلا فكاك) interrelated. Too much or too little health care can be harmful. The quest for high-quality care must include a search for financially neutral clinical decision making.

11 A Case for Discussion John Bunker (1970) found that the US performed twice the number of surgical procedure per capita that GB did. WHY? In the US, physician paid FFS.. In GB, physician were paid salary.

12 Physician’s Ownership of HCS Conflict of Interest The rates of use for MRI and CT scans were higher for physician-owned compared with non-physician owned facilities. Physicians received payment for performing x- rays and sonograms within their own offices obtained these examinations four times as often as physicians who referred the examinations to radiologists and received no reimbursement for the studies.

13 Another Case for Discussion: Underuse Payment by capitation, salaried employment by a for-profit business may lead to underuse. HMO Prepaid Health Plans (PHPs)

14 5) Organizing HC institutions to maximize quality. It very rare that human resource mean harm. Research shows that hospitals with higher nurse staffing have lower surgical complication rates and lower mortality rates. The case study of “dusty tan radiology envelope” Dozens of people & hundreds of processes influence the care of one person with one illness.