The individual healthcare experience is comprised of a series of procedures.  Each procedure begins with the first visit to a healthcare provider for a given condition, and ends with fulfillment of the condition's treatment.  An annual physical is relatively simple, and typically involves only one step.  More complicated conditions requiring surgery or other intensive treatments consist of multiple steps from beginning to end.  Whether the treatment requires just one step, or many, the entire process is considered one procedure.

The problem that consumers currently face is that each doctor has a different set of steps, treatments, and costs for the same procedure, and there is no way for consumers to determine which doctor or hospital can offer them the best care.  For example, while the elements that make up the procedure of having a baby with Doctor A closely resemble those of Doctor B, Doctor A charges $5,000 more than Doctor B.  This type of information leads to a very logical question: "Is the care I'm getting with Doctor A really worth $5,000 more than the care I could get with Doctor B?" and currently, consumers have no way to determine the answer.

This leads back to the post on this blog from June 17th, about "Consumer Reports" for healthcare.  If doctors and hospitals were required to provide a list of elements for a procedure, approximate costs for those elements, and data indicating the success rate of the procedure, consumers could directly compare Doctors A and B and make an informed decision about which doctor offers the best healthcare. 

While "Consumer Reports" for healthcare sound like a great idea on paper, there are currently a number of obstacles to making them a reality.  There are no set standard performance results for healthcare, meaning the level of care can differ greatly from one doctor or hospital to the next.  Also, the current system is set up to reward doctors with quantity of care rather than quality of care.  In other words, it is in the best interest of doctors financially to see as many patients as possible, thereby limiting time with each individual patient, and encouraging the prescription of treatments regardless of their effectiveness.  Furthermore, many in the medical community are resisting the reporting of physician performance data, which limits the consequences for doctors with poor performance levels.

Luckily, there is an increasing national push for the disclosure of data on cost and quality to the public.  NCQA is an organization "dedicated to improving health care quality" and they serve as an advocate for quality reporting in healthcare (to read their views on public reporting, click here).  Probably the biggest obstacle to quality reporting is the current payment system.  If physicians were paid based on quality rather than quantity, the process of setting standards of care and getting cooperation from the medical community in reporting physician performance data would likely become much easier.  The Commonwealth Fund has a great post on a payment system based on quality rather than quantity (to learn more, click here). 

Despite these obstacles, consumers are not without some resources.  There are many websites that provide information on the certification of physicians as well as rankings for hospitals based on a number of categories.  Though these sites still lack crucial information, they provide consumers with a means to begin educating themselves about their own healthcare, and the more educated consumers are about healthcare, the more power they will have to effect change and control the care that they receive.