Here are seven key thoughts:
1. The traditional philosophy in the hospital sector argues for “healthcare exceptionalism” — that hospitals fall don’t prey to market forces because poor performance doesn’t necessarily equate to less business; patients don’t pressure low-quality hospitals to improve. However, “healthcare exceptionalism” fails to take the hospital’s reputation, social media and the patient’s self-determination into account.
2. In one study, Harvard researchers examined high-quality hospitals and compared their market share with low performing hospitals. They found high-performing hospitals had greater market share and report higher market share growth than their competition over time.
3. Patients put demand-side pressure on healthcare providers, even in emergency situations. The researchers found heart attack patients would travel 1.8 miles more than necessary to receive treatment at a hospital with a higher risk-adjusted survival rate, even if the hospital had just a 1 percent higher survival rate. When patients had more choice over where they received treatment, the relationship between high performance and market share was greater, according to the report.
4. The hospitals that made technology and treatment improvements found those improvements weren’t enough to explain a 20 percent improvement in heart attack survival for Medicare patients from 1996 to 2008; reallocation of patients to higher-performing institutions can explain that trend.
5. The more productive hospitals reported better outcomes. In a second study, Harvard researchers found Medicare patients with myocardial infarction treated at a 90th percentile hospital were associated with 1.55 times higher survival rates than those treated at 10th percentile hospitals.
6. A patient’s social network may influence their decision about where to receive care. The article noted a New York Times piece estimated patients use social networks including friends and family, as well as referring physicians, when choosing the site of care. Patients tended to choose hospitals with higher patient survival rates, but didn’t penalize hospitals that used more tests presumably for better outcomes.
7. The article authors recommended the government focus anti-trust efforts on increasing competition, and not preventing a low-performing hospital from closing. “Otherwise, low performing hospitals are more likely to be able to stay in the market, stunning innovation and worsening patient outcomes,” according to the article.
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