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Commentary: a systematic review of health care efficiency measures.

Article Excerpt
Frustration with high costs and poor quality in American health care led private sector purchasers of health care benefits to form our organization, The Leapfrog Group, in 2000. Purchasers use Leapfrog to translate and then deploy the most important evidence about the levers that improve quality and reduce costs in hospital care. Leapfrog bridges the gap between the researchers and experts studying the value of health care services and business leaders writing the checks for those services. Our Leapfrog Hospital Survey is a publicly available dashboard of the National Quality Forum (NQF)-endorsed, evidence-based measures that research suggests have the greatest impact on quality, safety, and cost-effectiveness of hospital care. Employers and other purchasers use Leapfrog data to encourage beneficiaries to use the highest performing hospitals.

Given our organization's role mediating between purchasers and researchers we eagerly anticipated this review of the literature on health care efficiency (Hussey et al. 2009). Few issues are more critical to purchasers than efficiency; with rising insurance premiums eating away at profits in a down economy, purchasers look to us every day to plumb the literature for new strategies for reducing costs. But it is also important to purchasers that cost reductions not compromise quality. Investment of any magnitude in employee benefits is only worthwhile if employees are relatively satisfied and care is good. Dissatisfied, unhealthy employees, victims of poor quality care, contradict the very purpose of having health benefits in the first place. If purchasers invest in benefits, they want to see a benefit.

We are thus disappointed to learn from this review that most of the literature on health care efficiency does not account for quality outcomes. According to this review, nearly all of the studies under review defined efficiency by the resources and costs involved in particular functions within health care, without regard to the quality and outcome of the functions. While the number of workers and widgets needed to accomplish a task is certainly a factor in understanding efficiency, so is verification...

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