There is a well-proven adage in management circles: you get whatever you measure.
What do we measure in health care? We measure: length-of-hospital-stays; complications; deaths; immediate costs; lawsuits; and compliance with regulations.
Are those the things we really want? Of course not. How can we know that we got what we want if we do not measure it?
What we really want from our healthcare system is: sustained good health; continued productivity; restored function when ill; and long life. These results are hard to measure and take a long time. So we use substitute measures called surrogates. We count deaths and think we are getting what we want: life. But what kind of life?
The outcome you want after surgery is a return to a state of good health compared to the problems you had before surgery. If you are a cardiac patient, you want to breath easily (no shortness of breath); you want to be able to climb stairs (as a prerequisite for sex — see the movie Something’s Gotta Give); and to have no more chest pains, all of the former over many years. If you have bladder obstruction problems, after surgery, you want to be able to urinate easily and not to have bladder infections, over many years.
No one measures the outcomes we want. We do measure one thing carefully and completely: initial expenses. No one measures avoided costs – the money we do NOT have to spend because preventative care kept us well.
No one has evidence about the value – a long term cost benefit analysis – of what health care gives us over time compared to what it costs us over time.
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