Improving Health Care System Performance through Better Co-ordination of Care

Monitoring the performance of the health care delivery system is a public health function that becomes more important as organized delivery systems begin to take control over large portions of the medical care market. The study reported here illustrates how standard medical care epidemiology can be applied to analysis of health care system performance to aid governmental efforts to monitor new developments in the medical care market. In order to evaluate the efficiency of hospital care delivered in Iowa, age- and sex-adjusted population admission rates for five common procedures were generated for all 99 counties. The five common procedures were defined as follows: hernia, tonsillectomy, cesarean section, hysterectomy, and cholecystectomy. In addition, variations in 11 ambulatory care-sensitive condition rates were analyzed. Residents of at least 15 counties were at significantly greater than average risk for receiving each of the common procedures (χ2 test, P < 0.05). Counties that had a high rate for one procedure tended to have a high rate for at least one other procedure. Several counties had more than twice the mean rate. Even a 10% reduction, when added across all five common procedures, amounts to well over 2000 hospitalizations avoided. It is assumed that reductions would be concentrated in high-rate counties. If a 50% reduction could be achieved in only part of the ambulatory care-sensitive procedures, more than 10 000 hospital admissions could be avoided.

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Assessing Health-Care System Performance against the Four Core Aims of Health-Care Policy

Health Care as a Right of Citizenship ◽

10.7312/columbia/9780231170130.003.0007 ◽

2017 ◽

pp. 202-236

Author(s):

Gunnar Almgren

Keyword(s):

Public Health ◽

Health Care ◽

Health Care System ◽

Health Care Access ◽

System Performance ◽

Health Care Policy ◽

Care Policy ◽

Access And Quality ◽

Risk Protection ◽

Care System

Previous chapters have provided the historical context and the justification for a set of four core aims of health care policy in light of the requisites of citizenship in a democratic society, and then the basic structure of a reformed national health care system designed to achieve those core aims. Briefly stated, the four core policy aims include: comprehensive health insurance coverage with adequate and equal risk protection, the amelioration of disparities in health care access and quality, equitable comprehensive care and public health investments, and compensatory investments in health care services and public health infrastructure for groups adversely affected by health disparities. This chapter illuminates the major dimensions of health care system performance that are most closely linked to these core policy aims, the range of health care system measures specific to each dimension of performance, and those that appear optimal in light of validity and the pragmatics of data system design and sustainability. The chapter then concludes with a discussion of the criteria for health care policy “success”.

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