What Was Measured?
Comparisons of hospitalization rates for asthma of HMO members with asthma.
Why Is It Important?
We all know it is hard to separate cost from quality when making purchasing decisions in our personal lives. The same is true in healthcare, where costs continue to rise faster than the rate of inflation. Leaders in business and government are wrestling with strategies to control healthcare costs while maintaining and improving quality. Efficiency in healthcare can be defined as the cost of providing a high quality service. Efficiency is also one of the six domains of quality described by the Institute of Medicine. However, there is little information available on efficiency through well established healthcare quality measures such as HEDIS or CAHPS. One measure of efficiency is whether individual HMOs or particular types of health insurance do a good job of keeping patients with asthma healthy and out of the hospital. This is a measure of efficiency because it is less expensive to take care of patients in ambulatory settings such as clinics and doctors offices than it is to take care of them when they are sick in the hospital, and high quality care in ambulatory settings can keep patients with asthma out of the hospital. Because this information on equity was not obtained through a process specifically designed to measure healthcare quality, such as HEDIS or CAHPS, it is included in our Research and Background section.
What Was the Source?
The 2003 California Health Interview Survey (CHIS) was used to determine the prevalence of asthma in HMO enrollees and the type of health insurance. The 2003 Office of Statewide Health Planning and Development (OSHPD) inpatient hospital discharge data base was used to calculate the number of asthma hospitalizations in California in 2003 for the largest commercial private HMOs as well as for PPOs in California. Information from the website of Cattaneo and Stroud, a private accounting firm that monitors the HMO industry in California was used to calculate the number of members in each HMO in order to determine the rate of hospitalizations for HMO members with asthma.