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Health Insurance - A Quick Look at Quality Health
Care
Quality health care means doing the right thing, at the right time,
in the right way, for the right personand having the best
possible results.
Although we would like to think that every health plan, doctor,
hospital, and other provider gives high-quality care, this is not
always so. Quality varies, for many reasons.
Fortunately, there are scientific ways to measure health care quality.
These tools, called measures, have mostly been used by health professionals.
They use measures to check up on and improve the quality of care
they provide.
But there is some quality information you can use right now to
help you compare your health care choices. And more and more is
becoming available all the time. Many public and private groups
are working to improve and expand health care quality measures.
The goal is to make these measures more reliable, uniform, and helpful
to consumers in making health care choices.
What is Measured?
There are two main types of quality measures that can help you choose
quality health care: consumer ratings and clinical performance measures.
Both types are based on "outcomes research."
Outcomes research measures the end results of health care practices
and treatments. For example, after treatment, is the pain gone?
Can the patient carry out his or her daily activities? Is he/she
satisfied with his or her care?
Consumer ratings (or "consumer satisfaction" information).
These look at health care from the consumer's point of view. For
example, do doctors in the plan communicate well? Do members get
the health services they need?
Many consumer ratings of health plans are based on a survey called
the Consumer Assessment of Health Plans (CAHPS®) and on the
Health Plan Employer Data and Information Set (HEDIS) member satisfaction
survey, which includes CAHPS® questions.
Clinical performance measures (also sometimes called "technical
quality" measures). Some widely used clinical performance measures
are included in HEDIS. These measures look at how well a health
care organization prevents and treats illness. For example, one
HEDIS clinical performance measure looks at whether children get
the immunizations (shots) they need when they need them.
More information on CAHPS® and HEDIS is provided in the Choosing
a Health Plan section.
What Should I Look For?
Quality Reports. You may be able to find consumer ratings,
clinical performance measures, or both in quality reports. Quality
reports go by different names, including performance reports and
report cards. Quality reports don't tell you which health care choices
are the best. But they can help you decide which are best for you,
based on the things that are most important to you.
More information about quality reports is provided in the Choosing
a Health Plan and Choosing a Hospital sections.
Accreditation Reports. Another way to compare quality is
to use information about accreditation. Accreditation is a "seal
of approval." It is mainly used for health care organizations
such as health plans, hospitals, and nursing homes.
To earn accreditation, organizations must meet national standards,
often including clinical performance measures. Organizations choose
whether to participate in accreditation programs. Therefore, you
will not find accreditation information on every nursing home, for
example.
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