Universally, the three most important issues in any health care system worldwide are cost, quality, and access (Shi & Singh, 2008). Two of the issues, cost and access can be measured empirically, while the third one, quality is somehow of a subjective issue, so that McGlynn and Wasserman (2006) argued that health care quality may be a unique experience for each individual, thus metaphorically declaring it “To some extent, quality is in the eye of the beholder.” McGlynn and Wasserman claimed that the values and expectations for patients, health insurances, and providers regarding quality differ (cited in Shi & Singh, 2008). For example, patients view quality in the perspective of whether their individual needs are being met. In this role, for example, the traditional fee-for-service that rewarded physicians for doing everything for their patients may have shaped the way most patients defined quality. Because health insurance organizations value cost containment (e.g. limiting access to care or providers, shorter ambulatory care visits), it may be viewed negatively by patients. However, there will be some high level of quality care that health plans and doctors provide that may not be rated highly by patients on responsiveness, humaneness and satisfaction. Furthermore, according to (McGlynn & Wasserman, 2006), physicians are caught between third party decisions and their judgment and autonomy with regards to giving the best possible treatment for their patient.
A friend of mine, five years ago, had a meniscus tear in his left knee. After months of feeling chronic pain on his knees, he decided to have an elective surgery to remove the partial tear. He visited the surgeon in his office before the operation and was very pleased with the way his orthopedist had explained everything to him. The surgery went smoothly and he was back to work the following day and crutches were no longer needed after two days.
However, what started as a quality performance by the orthopedist was overshadowed by the poor post surgery plan for my friend as there were no follow up, no rehabilitation schedules (physical therapy) or follow up from his primary care physician. Just a few days ago, I saw the same friend with crutches favoring his left leg, and needless to say it was the same knee that he had surgery on that was giving him the problem. Looking back had there been therapy, the outcome would have been better, who knows?
The preceding example was just one of the chronic issues facing health care today. For insurance companies, quality means cost containment, containing as much possible cost, thus constraining physicians from giving the utmost care to their patients. Meanwhile, for patients, quality means getting the most out of health care and individual need gratification. In the perfect world, every surgery should be followed by the investigations of its outcome because in healthcare the customers are the patients, and customers are always right.
Cesar Aquino, PhD, MBA, CT(ASCP)