Healthcare Glossary

Quality Quest for Health of Illinois

Blog : Employers Can Help Build Healthcare Quality and Value

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By: Quality Quest Staff, on September 3, 2010

For employers, quality healthcare means having a healthy workforce, benefiting from increased productivity, and getting better value for each healthcare dollar. Sadly, Illinois healthcare ranks 42nd in the nation when it comes to overall population health (access, quality, avoidable hospital use and cost, equity, healthy lives). Quality improvement not only will provide better health and quality of life for employees, but offer cost savings for them and their employers.

Current state of affairs

As the second largest purchaser of healthcare in America, employers are paying for poor-quality, high-cost medical care. Poor-quality care comes in three forms:

Underuse: People do not receive the care they should get. Sometimes, providers neglect to give them medically necessary care or to follow proven healthcare practices.

Overuse: Americans get a lot of healthcare that doesn't help them. People are often treated without medical justification or are not offered equally effective options that cost less or cause fewer side effects.

Misuse: Errors are made throughout the healthcare system. Between 44,000 and 98,000 people die annually from preventable errors – more than from motorcycle vehicle accidents, breast cancer, or AIDS. Some errors are human, but systems within hospitals, doctor's offices, and elsewhere can be designed to greatly reduce the risk of error and harm.

Poor quality costs a typical employer between $1,900 and $2,250 per employee per year.¹ As healthcare costs spiral upward, more employers either decrease or drop healthcare benefits. Between 2000 and 2008, the percentage of businesses offering health insurance coverage to their employees declined from 69 to 63.²

Adding value

At Quality Quest, we define value in healthcare services as the quality of care administered divided by the cost to provide that care. In other words, the patient's outcomes and experience are the most important part of the equation. The value of the services provided is highest when the patient has a positive result, good experience, and the cost for such services is fair and equitable.

What this means for employers is that they are in a position to demand better quality for the healthcare dollars they spend. Besides bringing down out-of-control healthcare costs, helping employees manage their health is good for business. Employees who are healthier are more productive and they often need less medical services.

¹ Reducing the Cost of Poor-Quality Health Care Through Responsible Purchasing Leadership. Chicago. Midwest Business Group on Health. 2003.

² Kaiser Family Foundation, Employer Health Benefit Survey. Menlo Park, CA. Kaiser Family Foundation. 2009.


Purchasers of health care constitute anyone or any entity buying health care services.  This is a large stakeholder group that includes individuals, the federal government, and employers.  Purchasers are also referred to as payers.
Underuse refers to the failure to provide a health care service when it would have produced a favorable outcome for a patient. Standard examples include failure to provide appropriate preventive services to eligible patients (e.g., Pap smears, flu shots for elderly patients, screening for hypertension) and proven medications for chronic illnesses (steroid inhalers for asthmatics; aspirin, beta-blockers and lipid-lowering agents for patients who have suffered a recent myocardial infarction).
Overuse describes a process of care in circumstances where the potential for harm exceeds the potential for benefit. Prescribing an antibiotic for a viral infection like a cold, for which antibiotics are ineffective, constitutes Overuse. The potential for harm includes adverse reactions to the antibiotics and increases in antibiotic resistance among bacteria in the community. Overuse can also apply to diagnostic tests and surgical procedures.
Misuse occurs when an appropriate process of care has been selected, but a preventable complication occurs and the patient does not receive the full potential benefit of the service. Avoidable complications of surgery or medication use are Misuse problems. A patient who suffers a rash after receiving penicillin for strep throat, despite having a known allergy to that antibiotic, is an example of Misuse. A patient who develops a pneumothorax after an inexperienced operator attempted to insert a subclavian line would represent another example of Misuse.
Benefits are what insurance pays to cover consumer health services.  A Benefits package specifies what services and products an insurance plan will pay for and plans typically offer several different benefit packages at different costs.  The word "Benefits" can also mean the good results of a treatment or lifestyle change.