Question: In what way should health care be focused on outcomes?
Regina Herzlinger: What do we know about outcomes in health care? Well let's say you needed a mastectomy. How much would you know about the surgeon who's going to perform that mastectomy on you? About her mortality rates? How many people like you died when they got this surgery? About her morbidity rates? How many people became infirm? How many people got a deadly clot? How many people had a sponge left inside their body? How many people got an infection that they absolutely could not shake? How many people were readmitted 30 days, 60 days, 90 days, to keep repairing what's going wrong with that surgery? Do you know where you could find that information? I don't either.
Clearly what we need is much more transparency in health care.
I have long proposed the health care equivalent of the SEC [Securities Exchange Commission]. The SEC has been a miserable failure in its regulatory functions, but transparency--it's incredible. Countries all over the world emulate the transparency functions of the SEC. I can go to the SEC's website and within three seconds I can find most of what I would want to know about any publicly traded corporation.
What can I know about my doctor, my hospital, my insurer, my dialysis center? Zero.
We need a federal agency that forces disclosure of outcomes. And by outcomes I mean, real outcomes. How many people died? How many people get a clot? How many people get an infection? How many people can function well after whatever is done to them? That's one thing of what we need.
Once we measure outcomes, the health care system will reorganize itself so that it can deliver outcomes. Right now, it can't make you better for your diabetes, your AIDS, your heart disease. All it can do is optimize the hospital part of that, optimize the doctor part of it, optimize the laboratory part of it.
Anybody who studied systems analysis knows if you optimize all the many little pieces of the system, that's not the same as optimizing the whole system. A system that measures outcomes will force a change in how health care is delivered. That will make it simultaneously better and cheaper.
Recorded on: May 27, 2009.