Ways to Improve Hospital Quality - A Health System Perspective Comment on "Hospitals Bending the Cost Curve With Increased Quality: A Scoping Review Into Integrated Hospital Strategies"

Abstract

Wackers and colleagues’ scoping review provides an informative and well-structured overview of hospital-based case studies focusing on integrated hospital strategies that seek to improve quality, while reducing or containing costs. Wackers et al take a hospital level perspective and evaluate facilitators and barriers to the successful implementation of those hospital strategies. I complement the hospital level perspective of Wackers et al with an analysis from a health system perspective. Regulations at the superordinate system level might influence decisions at the hospital level that are relevant for costs and quality of care. In this commentary, I discuss how interventions at the system level might affect hospital quality. The results suggest that especially competition between hospitals, pay for performance (PfP) initiatives in combination with publication of quality information, but also greater experience of hospital staff (as proxied by the volume outcome relationship) may provide impulses for improving quality of care.

How to Design Integrated Strategies to Improve Healthcare Quality Whilst Containing Healthcare Costs? A Response to the Recent Commentaries

“…While policy-makers cannot enforce upon hospitals to implement a strategy to improve quality while containing costs, governments could improve the health system climate to be more beneficial to the development of these initiatives, as Wuebker points out. 2 For example, broad outcome-based payment systems may support integrated strategies. 11 Furthermore, an integrated hospital strategy to improve quality whilst containing costs could be profitable in a competitive environment, when patients can be directed towards the most efficient provider.…”