مجلة موقع ووردبريس عربي آخر
When it comes to improving healthcare in the United States, most discussions revolve around the twin pillars of quality and cost: Will higher expenditures result in better care, or will better clinical outcomes help to contain costs?
In a review of the evidence currently available, there was no clear relationship between the 2, leading the authors of an article published in the January 2013 issue of the Annals of Internal Medicine to conclude that the association between healthcare cost and quality is still poorly understood.
Lead author Peter S. Hussey, PhD, from RAND Health, Arlington, Virginia, and colleagues conducted a systematic review of 61 studies and “found inconsistent evidence on both the direction and the magnitude of the association between health care costs and quality,” they write. “To our knowledge, there has been no previous systematic literature review of evidence on the cost–quality association in health care.”
One problem Dr. Hussey and colleagues found was that studies varied widely in the way they defined costs and in the levels of analysis they employed. However, the findings remained inconsistent even after Dr. Hussey and colleagues controlled for these differences.
“These results are a stark reminder of how little researchers and caregivers know about the optimal allocation of scarce health care resources to achieve the best health outcomes,” Alyna T. Chien, MD, from Harvard Medical School and Boston Children’s Hospital in Massachusetts, and Meredith B. Rosenthal, PhD, from the Harvard School of Public Health, write in an accompanying editorial.
The investigators searched the PubMed, EconLit, and EMBASE databases for relevant studies published between January 1, 1990, and June 10, 2012. The search also included studies gleaned from the bibliographies of selected papers, as well as informal searches and consultations with outside experts. Two of the authors independently reviewed and abstracted the data. For each study reviewed, outcomes of interest were the magnitude and direction of the association between cost and quality as well as the statistical significance of that association
