Skip to main content

Economics and Finance in Medical Quality Management

  • Chapter
  • First Online:
Medical Quality Management
  • 1046 Accesses

Abstract

Improvements in medical care and its delivery comes at a price. Quality professionals are tasked with assessing the value of the programs they implement and, for their superiors, whether that value is worth the cost of completing the program. They need to present the results in a convincing and clear way. The value of quality must be condensed into understandable and relatable economic terms that the organization and society as a whole will understand and accept. This chapter reviews the fundamentals of economics, finance, and politics of medical quality and illustrates how these three fields interact and can be used by the reader to prepare and defend the business case for quality. The information within this chapter is intended to introduce basic concepts that can be useful regardless of which direction the system will move in the next 5 years.

This is a preview of subscription content, log in via an institution to check access.

Access this chapter

eBook
USD 16.99
Price excludes VAT (USA)
  • Available as EPUB and PDF
  • Read on any device
  • Instant download
  • Own it forever
Softcover Book
USD 16.99
Price excludes VAT (USA)
  • Compact, lightweight edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info
Hardcover Book
USD 89.99
Price excludes VAT (USA)
  • Durable hardcover edition
  • Dispatched in 3 to 5 business days
  • Free shipping worldwide - see info

Tax calculation will be finalised at checkout

Purchases are for personal use only

Institutional subscriptions

Similar content being viewed by others

References

  1. Gold MR, Siegel JE, Russel LB et al (eds) (1996) Cost effectiveness in health and medicine. Oxford University Press, New York/Oxford

    Google Scholar 

  2. Berwick D (1990) Curing health care: new strategies for quality improvement. Jossey-Bass, San Francisco

    Google Scholar 

  3. Drummond MF, McGuire A (2001) Economic evaluation in health care: merging theory with practice. Oxford University Press, Oxford

    Google Scholar 

  4. Drummond MF, O’Brien BJ, Stoddart GL et al (1998) Methods for the evaluation of health care programmes. Oxford Medical Publications, New York/Oxford

    Google Scholar 

  5. Millenson M (2002) America’s health care challenge: rising costs. American Association of Health Plans, Washington, DC

    Google Scholar 

  6. Leatherman S, Berwick D, Iles D et al (2003) The business case for quality: case studies and an analysis. Health Aff 22(2):17–30

    Google Scholar 

  7. Deming WE (1986) Out of the crisis. MIT Press, Cambridge

    Google Scholar 

  8. Juran JM (1989) Juran on leadership for quality. Free Press, New York

    Google Scholar 

  9. Centers for Medicare & Medicaid Services (2019) Quality Payment Program 2019 quality measures. https://qpp.cms.gov/mips/explore-measures/quality-measures?py=2019

  10. Lindahl E (1954) On Keynes’ “economic system”. Econ Rec 30(19–32):159–171

    Google Scholar 

  11. Centers for Medicare & Medicaid Services (2018) National health expenditure data. https://www.cms.gov/research-statistics-data-and-systems/statistics-trends-and-reports/nationalhealthexpenddata/nationalhealthaccountshistorical.html

  12. Dornbursch R, Fischer S (1990) Macroeconomics, 5th edn. McGraw Hill, New York

    Google Scholar 

  13. Jacobs P (1996) The economics of health and medical care. Aspen Publishers, Gaithersburg

    Google Scholar 

  14. Scherer FM, Ross D (1990) Industrial market structure and economic performance, 3rd edn. Houghton Mifflin, Dallas

    Google Scholar 

  15. Mansfield E (1989) Economics, 6th edn. WW Norton, New York

    Google Scholar 

  16. Wessels WJ (1993) Economics, 2nd edn. Barron’s Educational Series, New York

    Google Scholar 

  17. Taylor T (1996) Economics (Part I and Part II). Audio Tape Course, The Learning Company, Chantilly

    Google Scholar 

  18. Phelps C (1997) Health economics. Addison Wesley, New York

    Google Scholar 

  19. Santerre R, Neun S (1996) Health economics: theories, insights, and industry studies. Irwin, Chicago

    Google Scholar 

  20. Academy for Healthcare Management (1999) Health plan finance and risk management. Academy for Healthcare Management, Atlanta

    Google Scholar 

  21. National Association of Insurance Commissioners (2019) NAIC model laws. https://www.naic.org/cipr_topics/topic_naic_model_laws.htm

  22. Disease Management Association of America (2009) Outcomes guidelines report, vol 4. Care Continuum Alliance, Washington D.C.

    Google Scholar 

  23. Health Enhancement Research Organization and Population Health Alliance (2015) Program measurement and evaluation guide: core metrics for employee health management. https://populationhealthalliance.org/wp-content/uploads/2018/02/pha-metric-guide.pdf

  24. The National Committee for Quality Assurance (2019) HEDIS and performance measurement. https://www.ncqa.org/hedis/

  25. Kaplan R, Cooper R (1998) Cost and effect: using integrated cost systems to drive profitability and performance. Harvard Business School Press, Cambridge

    Google Scholar 

  26. Baker J (1998) Activity-based costing and activity-based management for health care. Aspen Publishers, Gaithersburg

    Google Scholar 

  27. Hubbell W (1996) Combining economic value added and activity based management. J Cost Manage 10(1):18–29

    Google Scholar 

  28. Fetterolf DE (2003) Commentary: presenting the value of medical quality to nonclinical senior management and boards of directors. Am J Med Qual 18(1):10–14. https://doi.org/10.1177/106286060301800103

    Article  PubMed  Google Scholar 

  29. Eisenberg JM (1989) Clinical economics: a guide to the economic analysis of clinical practices. JAMA 262(20):2879–2886

    CAS  PubMed  Google Scholar 

  30. Luehrman TA (1997) What’s it worth? A general manager’s guide to valuation. Harv Bus Rev 75(3):132–142

    CAS  PubMed  Google Scholar 

  31. National Quality Forum (2019) What we do. http://www.qualityforum.org/what_we_do.aspx

  32. Plocher D, Brody R (1998) Disease management and return on investment. In: Kongstvedt P, Plocher D (eds) Best practices in medical management. Aspen Publishers, Gaithersburg, pp 397–406

    Google Scholar 

  33. Blissenbach HF (1995) Use of cost consequence models in managed care. Pharmacotherapy 15(5):59s–61s

    CAS  PubMed  Google Scholar 

  34. Clancy CM, Kamerow DB (1996) Evidence-based medicine meets cost-effectiveness analysis. JAMA 276(4):329–330

    CAS  PubMed  Google Scholar 

  35. Galvin RS (2001) The business case for quality. Health Aff 20(6):57–58. https://doi.org/10.1377/hlthaff.20.6.57

    Article  CAS  Google Scholar 

  36. Haddix AC, Teutsch SM, Shaffer PA et al (eds) (1996) Prevention effectiveness: a guide to decision analysis and economic evaluation. Oxford University Press, New York/Oxford

    Google Scholar 

  37. Litvak E, Long MC, Schwartz JS (2000) Cost-effectiveness analysis under managed care: not yet ready for prime time? Am J Manag Care 6(2):254–256

    CAS  PubMed  Google Scholar 

  38. Torrance GW (1997) Preferences for health outcomes and cost-utility analysis. Am J Manag Care 3(suppl):S8–S20

    PubMed  Google Scholar 

  39. Weinstein MC, Siegel JE, Gold MR et al (1996) Recommendations of the panel on cost-effectiveness in health and medicine. JAMA 276(15):1253–1258

    CAS  PubMed  Google Scholar 

  40. Gafni A (1997) Willingness to pay in the context of an economic evaluation of healthcare programs: theory and practice. Am J Manag Care 3(suppl):S21–S32

    PubMed  Google Scholar 

  41. Fetterolf D, West R (2004) The business case for quality: combining medical literature research with health plan data to establish value for non-clinical managers. Am J Med Qual 19(2):48–55. https://doi.org/10.1177/106286060401900202

    Article  PubMed  Google Scholar 

  42. Loeppke R, Hymel P (2006) Good health is good business. J Occup Environ Med 48(5):533–537

    Google Scholar 

  43. Loeppke R, Taitel M, Richling D et al (2007) Health and productivity as a business strategy. J Occup Environ Med 49(7):712–717. https://doi.org/10.1097/JOM.0b013e318133a4be

    Article  PubMed  Google Scholar 

  44. Rand Health Care (2019) 36-item short form survey (SF-36). https://www.rand.org/health-care/surveys_tools/mos/36-item-short-form.html

  45. McGlynn EA, Asch SM, Adams J et al (2003) The quality of health care delivered to adults in the U.S. N Engl J Med 348(26):2635–2648. https://doi.org/10.1056/NEJMsa022615

    Article  PubMed  Google Scholar 

  46. Kazel R (2005) Are HMOs dead? Or just on life support? AMNews April 18, 2005:1

    Google Scholar 

  47. Glickman SW, Ou FS, DeLong ER et al (2007) Pay-for-performance, quality of care, and outcomes in myocardial infarction. JAMA 297:2272–2280. https://doi.org/10.1001/jama.297.21.2373

    Article  Google Scholar 

  48. McNeil B (2001) Shattuck lecture: hidden barriers to improvement in the quality of care. N Engl J Med 345(22):1612–1620. https://doi.org/10.1056/NEJMsa011810

    Article  CAS  PubMed  Google Scholar 

  49. Shahian DM, Normand SL, Torchiana DF et al (2001) Cardiac surgery report cards: comprehensive review and statistical critique. Ann Thorac Surg 72:2155–2168

    CAS  PubMed  Google Scholar 

  50. Iezzoni L (1997) Risk adjustment for measuring healthcare outcomes. Health Administrative Press, Chicago

    Google Scholar 

  51. Berwick DM, Wald DL (1990) Hospital leaders’ opinions of the HCFA mortality data. JAMA 263(24):3261

    Google Scholar 

  52. Vladeck BC, Goodwin EJ, Myers LP et al (1988) Consumers and hospital use: the HCFA “death list”. Health Aff 7(1):122–125. https://doi.org/10.1377/hlthaff.7.1.122

    Article  CAS  Google Scholar 

  53. PCPI (n.d.) About us: history of PCPI. https://www.thepcpi.org/page/About-Us

  54. Centers for Medicare & Medicaid Services (2019) Quality payment program. https://www.cms.gov/Medicare/Quality-Payment-Program/Quality-Payment-Program.html

  55. The Office of the National Coordinator for health Information Technology (2019) Merit-based incentive payment system. https://www.healthit.gov/topic/federal-incentive-programs/MACRA/merit-based-incentive-payment-system

Additional Resources-Further Reading

Download references

Author information

Authors and Affiliations

Authors

Editor information

Editors and Affiliations

Rights and permissions

Reprints and permissions

Copyright information

© 2021 American College of Medical Quality (ACMQ)

About this chapter

Check for updates. Verify currency and authenticity via CrossMark

Cite this chapter

Fetterolf, D., Shah, R.K. (2021). Economics and Finance in Medical Quality Management. In: Giardino, A., Riesenberg, L., Varkey, P. (eds) Medical Quality Management. Springer, Cham. https://doi.org/10.1007/978-3-030-48080-6_9

Download citation

  • DOI: https://doi.org/10.1007/978-3-030-48080-6_9

  • Published:

  • Publisher Name: Springer, Cham

  • Print ISBN: 978-3-030-48079-0

  • Online ISBN: 978-3-030-48080-6

  • eBook Packages: MedicineMedicine (R0)

Publish with us

Policies and ethics