Andrew Jones on health outcomes

Andrew Jones

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One thing that seems to be uniting healthcare policy makers is the urge to tackle so-called health inflation.

We have seen primary tenders for health centres turn into bidding contests with a race to the bottom on price. And it is no different in independent healthcare, with one of the big insurers leveraging market dominance in setting the price for a single-part MRI scan at £350 - take it or leave it!

Don't get me wrong - if I were running a primary care trust or an insurance network, I would be pursuing a similar strategy with one caveat.

Measuring outcomes

Astronaut John Glenn was once asked what went through his mind as he awaited the space shuttle's lift-off: "You're thinking you're sitting on top of the most complex machine ever built by man, with a million separate components, all supplied by the lowest bidder."

For those intent on pursuing the giant race to the bottom in health, it might pay to pause and reflect. NASA now calculates the risk of failure for all its components. So, should we change what we measure in healthcare?

As stated in a recent Office of Health Economics report, it is staggering how little we know about the outcomes of care in an industry that spends £100bn of taxpayers' money.

We have a plethora of process information in health, plenty of targets to hit and an increasing understanding of service line economics and cost-efficiency. All to the good, but it is almost impossible to judge how treatments compare on a like for like basis at different parts of the illness cycle.

Most of us could quickly fathom the return on investment for a new piece of kit such as an MRI based on current activity, but would we know what the outcome benefits for such a scanner would be for various disease pathways? Should everyone with a headache have a scan?

Making changes

So what is the solution for providers feeling the squeeze? The answer has to be quality, and the measures to align the system have to be outcomes. Let me paint a picture of a world without top-down targets. If I were given three wishes in healthcare (after abolishing just about every top-down target in existence) they would be as follows:

• to universally collate independent user satisfaction scores to assess the responsiveness, accessibility and quality of healthcare delivered;

• to create a quality and outcome performance system for secondary care to measure the outputs of that care, such as readmission or 30-day survival;

• to roll out a system of patient-reported outcome measures for all elective procedures and many chronic conditions.

The purpose of all this effort would be to align many parts of the system. Outcome measures and satisfaction scores could then be built into contractual performance. Staff could be rewarded based on the quality of care. The top-down imperative for one size fits all would disappear as local solutions evolve to fit local needs.

Most of all, open publication of provider performance would put the pride back into services, push clinicians and managers to innovate and give patients a real choice as institutions compete.

While the rest of the health community seems determined to hard landscape primary care and district hospitals, I would rather devise a system to measure the benefits of care and then allow local innovation to find the answers.