Cart before the horse.

The California HealthCare Foundation today unveiled a free-to-the-public hospital report card at

I took it for a quick spin and now feel thankful that I live in Sacramento, where two of the hospitals near me are “superior” and three are “average.” By comparison, Bakersfield’s best hospital is “below average,” while the rest are “poor.” San Francisco, on the other hand, has four of 11 hospitals rated “superior.”

I can see this being helpful if I was planning a heart bypass surgery, child birth, or looking around to see which hospital would best treat my pneumonia. But if I was having a heart attack (assuming it was bad enough that i couldn’t drive myself) I don’t think I could be aware enough to tell the ambulance driver — from the stretcher — that Hospital X has a “poor” rating, please take me to Hospital Y.

Moreover, if I am really expected to shop for “cost,” as well as quality as consumer-driven plan boosters would like, I can’t. That comparative information doesn’t exist.

Don’t misread my fussiness. I think CHCF has done a huge public service and went through considerable effort to achieve this. Here’s the eye-crossing account of what they went through to get these ratings:

The investigative phase of the CHART project, led by researchers at the
University of California, San Francisco’s Institute for Health Policy Studies
and supported by the California HealthCare Foundation, ran from May 2004 to July 2005. A broad group of stakeholders, working collaboratively, served as a
steering committee and participated in advisory groups. Participants included
representatives from hospitals, health plans, health care purchasers and the
business community, consumers, the research community, and government. To
support their work, especially the selection of complex quality measures, a
number of smaller workgroups were also formed.

What strikes me is that this — and other quality measures (available in the “Resources and Tools” section of their website) have all only recently come available and are all extremely nascent.

Consumer-driven health care, however, has been around for about a half-dozen years (tax-free Health Savings Accounts were created in 2003 and had precursors in HRAs). The premise of these plans was to put consumers in the driver’s seat. But if it took teams of researchers with lots of letters behind their names 13 months, plus lots of stakeholders and lots of meetings to get this level of detail, what was a consumer to do during the interim?

And even now that some tools are beginning to be available, I would argue that it’s hardly enough.

Government sites assume you have some knowledge about what is supposed to happen the moment you get to the hospital. (unless you’ve already had a heart attack and you know what the drill is.) Another site gives most hospitals the “Gold Seal of Approval” including those that CalHospitalCompare said were “below average.” All this could be confusing and a huge turnoff to consumers embarking on their first consumer-directed health shopping.

The efforts that have been made are extremely important for health shoppers. The more information consumers can get, the better. And I assume this is just version 1 of many comparison sites to come.

But at this point, it’s still a little premature for policy makers to really rely on the consumer-driven approach to provide the savings and change people’s care-seeking habits, based on a scattering of spare websites.

That’s putting the cart WAAAAYY before the horse.

Health Access California promotes quality, affordable health care for all Californians.
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