The University of Texas at Austin
  • Toward a better quality of health care

    By Ronen Avraham
    Ronen Avraham
    Published: Oct. 14, 2010

    Ronen Avraham is Thomas Shelton Maxey Professor in Law at the School of Law. His primary research interests are the economic analysis of torts and medical malpractice law, specifically how liability reform can influence health care reform. Avraham also writes about contract theory and theories of justice. He is the author of “Private Regulation,” an article about a new approach to the delivery of health care.

    In an earlier post I mentioned there are three broad goals all can agree would benefit the health care system:

    1. increasing access for the uninsured,
    2. improving the quality of care and
    3. controlling rising costs.

    Here, I discuss the second goal.

    Quality of care is an important facet of the health care landscape. Misuse is incorrect care, often referred to as medical errors. Misuse is bad for two reasons. First, medical errors are bad because they cause bad direct consequences, about 300,000 annual injuries (one-third of which are deaths). This is about twice as many deaths as from car accidents.

    On top of the direct consequences, misuse increases costs. Every time someone is readmitted into a hospital, misses additional days of work due to illness or suffers pain due to a preventable mistake, money is taken from the general economy and spent on health care. In this way, costs and quality are intimately intertwined.

    One of the best ways to increase quality is through evidence-based medicine, which incorporates both the most reliable up-to-date research and specific information regarding patient responses to specific treatments. Evidence-based medicine is an effort to move doctoring away from art and toward science.

    An ancillary focus of the Patient Protection and Affordable Care Act (PPACA), the recent health care reform law signed by President Obama, is increasing the quality of care through the incorporation of evidence-based medicine. That act, as well as the 2010 stimulus act, contains provisions that allocate grants to improve the quality of care. Specifically, relatively small grants are offered to fund projects that increase patient-doctor communication, help prevent mistakes and deal with the aftermath of the mistakes that do happen.

    Furthermore, as some Obama staffers have recently written, the PPACA attempts to increase quality by incentivizing vertical integration. The act attempts to push doctors to join hospital systems or accountable care organizations. Such integration, they argue, would allow doctors to marshal available resources to better track patient outcomes and incorporate the latest research.

    This is all good, but not good enough.

    One of most important reasons the PPACA does not go far enough is that it does not provide for, nor are there currently, the organizations necessary to gather and analyze the ever increasing universe of medical research and translate it to specific treatments for specific patients. Under the current regime, it takes good research 17 years to be incorporated into practice. It is therefore crucial, moving forward, to find ways to improve the quality of information making its way to doctors.

    Still, the PPACA is at least a step in the right direction. The common Republican substitute — tort reform — might have a negative effect on quality of care. The purpose of medical malpractice is to make doctors bear the cost of their mistakes. If malpractice recovery is limited –  which is what tort reform does — it takes away an incentive for doctors to be cautious and instead gives them leeway to use less caution than ideal. That might create more problems of medical errors and lead to more costs.

    As with underuse, the PPACA does not go far enough combating medical errors. It does, however, take important steps toward fostering a system where doctors have the resources to incorporate the latest evidence-based medicine into their practices. Thus, the PPACA takes an important step in the right direction. However, because the act is so expensive, the problem of rising costs becomes even more important and must be dealt with. Otherwise, rising costs will lead employers to drop health insurance and the huge achievement of the PPACA (covering 32 million previously uninsured people) will disappear faster than we could imagine.

    More election posts from Ronen Avraham:

    Visit the mid-term elections blog series home page for a complete lineup of faculty experts’ analyses.

    • Quote 2
      lola said on July 13, 2011 at 3:11 p.m.
      I really hope that the rising costs do not have too many negative repercussions. Thanks for the Informative Article
    • Quote 2
      RROD said on Feb. 21, 2011 at 2:57 a.m.
      I do Agree with the commenter above that Only way to reduce/minimize the medical errors is to ease the pressure of the medical doctors/staffs but a penalty hanging over their head will also contribute to their performance in a way that they have to take the utmost care when dealing with patients... so it's 50/50 Nice post, Thanks.
    • Quote 2
      ColdS said on Feb. 10, 2011 at 1:54 a.m.
      I don't agree with the assumption that only way to avoid medical errors/negligence is to issue penalties, of course we need legal remedies without a doubt,but in my humble opinion easing the pressure/workload on the part of the doctors will go a long way of reducing the medial errors, it's a nice article by the way.
    • Quote 2
      carseat said on Feb. 3, 2011 at 5:05 p.m.
      I really hope that the rising costs do not have too many negative repercussions. Thanks for the Informative Article
    • Quote 2
      tinnitus treatment colorado said on Jan. 20, 2011 at 3:38 a.m.
      No competent doctor ever begins a day without a sense of needing the utmost care to support the Hippocratic Oath- first do no harm. Continuing current tort reform adds oodles to health care cost but some leqal remedies are appropriate for true medical errors that cause harm. Hence, as I see it
    • Quote 2
      Terry said on Jan. 5, 2011 at 6:53 p.m.
      It certainly would be nice if our country's leaders could come together and agree on something worthwhile. I somehow don't think that's going to happen anytime soon, though. I won't hold my breath.
    • Quote 2
      fsin said on Dec. 27, 2010 at 9:48 p.m.
      Nice article.. It's absolutely true that "costs and quality are intimately intertwined" in my view reducing the workload on the doctors,may minimize the medical errors, as you've pointed out PPACA is at least a step in the right direction, any action towards the betterment is better than no action..Thanks
    • Quote 2
      Dave Mange said on Nov. 21, 2010 at 10:12 a.m.
      I was fascinated with the information on your blog. Thank you for your work.
    • Quote 2
      Tom said on Nov. 11, 2010 at 12:51 p.m.
      You easily assume the only way to avoid medical mistakes is to provide an atmosphere of penalties looming with each patient encounter. No competent doctor ever begins a day without a sense of needing the utmost care to support the Hippocratic Oath- first do no harm. Continuing current tort reform adds oodles to health care cost but some leqal remedies are appropriate for true medical errors that cause harm. Hence, as I see it, a better balancing act is needed to decrease the costs imposed by supporting the legal profession(that is a hugh contributor to democratic politicians that support tort law without limits) that benefits from theoretical tort excesses while providing protection for truly injured patients(do not support republicans that want to remove tort protection totally- in other words remove the issue from politics). To accomplish removing the issue from politics and providing proper amounts of tort relief would require what you recommend to improve medical practice- that is research as to what type and amount of tort reform would continue proper patient protection while not adding so much to the cost of medical care. Without such knowledge assumptions of "too much " or "too little" tort relief will deserve to be in the political arena, will continue to be unresolved, and will add to the ability of opposing factions to inproperly imply that their unsupported assumptions actually may have some bosis in truth. We need research.
    • Quote 2
      Michelle Legal said on Nov. 2, 2010 at 10:23 a.m.
      Quality of care is a top priority by far. By decreasing the number of medical malfunctions (and decreasing medical malpractice lawsuits), we can ensure that we are providing essential health care. We need doctors to have a negative effect if they make mistakes or use negligence when caring for a patient. I agree, it may create more problems of medical errors and thus increase costs if the tort reform is implemented.
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