Insight, analysis & opinion from Joe Paduda

< Back to Home


US healthcare quality is poor because…

Consumers don’t care.

Yesterday we dove into the disconnect between patient satisfaction (my nurse was sooo nice and my room…wow!) and quality of care (how likely was I to die).

Today, we focus on how this affects our healthcare. Or, as the researchers put it;

In an era of management by satisfaction survey, how does hospital competition shape the kind of medical services offered to patients? 

Leaving out the coefficients, standardized deviations, null estimates and other researchers’ esoterica, we find:

Local competition among hospitals leads to higher patient satisfaction, but lower medical quality. 

Yep, because we consumers value quiet rooms and nice nurses more than surviving an operation, health care facilities seem to focus more on quietness and niceness than on, you know, patients actually surviving.

And that’s because hospitals are competing desperately for private-pay patients, the ones insured by employers that pay three times more than Medicare. As the authors put it;

as a business strategy, investing in hospitality and hotel amenities offers a much higher return than medical quality. 

this research speaks to broad concerns about the unintended consequences of marketization…Hospitals have traditionally been conceived as an essential service to a community, but are becoming more like products in a consumer marketplace.

Those working in hospitals are increasingly expected to focus on the pursuit of customer satisfaction.

The day-to-day institutional question is shifting from “will this improve patient health?” to “will this raise satisfaction scores?” 

What does this mean for you?

Depends… life > comfort?

2 thoughts on “US healthcare quality is poor because…”

  1. Sorry Joe, have to disagree… healthcare is all about profit..Doctors are writing orders for acute rehab and insurance companies are denying to put their members in skilled care faclities. It does matter what the patient wants, what the doctor orders, if the patient is accepted to meet that level of care….it the payers who is running the show………………………you can’t have safe, quality, cost effective care in this environment..

    1. Hi Anne – Not sure we disagree.

      Healthcare delivery by facilities is a primary determinant of outcomes, and outcomes are poor in large part because facilities are not focusing on quality – because their customers don’t care about real quality but rather their perception of customer service.

      Payers do a poor job of improving outcomes as well – benefit design is a main culprit. High deductibles disincentivize people from primary care.

      Unfortunately what patients want may – or may not – be what they need to improve. For example, providers’ recommendations that patients engage in weight management and exercise are often ignored, thud yeti patient requires care to fix problems that the patient should have avoided.

      be well Joe

Comments are closed.

Joe Paduda is the principal of Health Strategy Associates



A national consulting firm specializing in managed care for workers’ compensation, group health and auto, and health care cost containment. We serve insurers, employers and health care providers.



© Joe Paduda 2024. We encourage links to any material on this page. Fair use excerpts of material written by Joe Paduda may be used with attribution to Joe Paduda, Managed Care Matters.

Note: Some material on this page may be excerpted from other sources. In such cases, copyright is retained by the respective authors of those sources.