There are many opportunities to exert leverage on the health care system to improve quality. Quality assurance systems are often not apparent to consumers, but have the potential to greatly affect their care:

  • large employer groups are holding managed care plans accountable for quality performance goals;
  • the Health Care Financing Administration (HCFA, which funds Medicare and the federal component of Medicaid) requires Medicare and Medicaid health plans to produce standard quality reports; and
  • state Medicaid programs are beginning to include quality provisions in their contracts with plans and providers.

Six of ten new cancer cases occur among people age 65 and older and, consequently, Medicare is the principal payer for cancer care. There is generally a lack of quality-related data from fee-for-service providers from whom most Medicare beneficiaries receive their care. Information systems are, however, in place that allow the reporting on a regional basis of some quality indicators (e.g., cancer screening rates) relevant to those in fee-for-service systems. For Medicare beneficiaries in managed care plans, accountability systems should incorporate core measures of quality cancer care.

Cancer care quality measures should be applied to care provided through the Medicare and Medicaid programs as a requirement for participation in these programs.

The collection, reporting, and analysis of information about the quality of cancer care will be expensive. Many segments of the health care industry will invest in information systems to maximize efficiency and to stay competitive, however, some may require incentives to provide patient-level data.

Information about quality cancer care is becoming more available to individuals with cancer (or at risk for cancer), but it is not yet easily accessible or understandable to consumers. A number of potential quality indicators can be listed, but most have not been evaluated to assess their ultimate value for consumers. It is unclear, for example, how the following indicators affect an individual's experience of care or health care outcomes:

  • a physician's board certification,
  • a hospital's approval status, for example, as determined by the American College of Surgeons' Commission on Cancer, and
  • a health plan's accreditation status and quality scores from the National Committee for Quality Assurance.

By the time a diagnosis of cancer is made and individuals have a clear reason to seek quality care, it is often too late to switch health plans. Also, even if they wanted to, most people do not have access to alternative plans. Individuals may use available quality indicators to choose doctors and hospitals within their plans, and perhaps to choose alternative courses of treatment, but evidence suggests that individual consumers can exert only a modest ''market'' pressure for quality improvement through access to better information about the quality of cancer care. Large purchasers such as employers, are likely to exert more leverage, and to have designated staff to assess alternative plans.

The National Academies of Sciences, Engineering, and Medicine
500 Fifth St. N.W. | Washington, D.C. 20001

Copyright © National Academy of Sciences. All rights reserved.
Terms of Use and Privacy Statement