A study of health care quality, its measures, and its relationship to cost in hospitals with various characteristics

Health care expenditures are very high in the U.S., and ideas and ways to reduce them is a widely discussed issue. Improving the quality of health care can be one way to reduce unnecessary expenditure. In this thesis, we review papers which discuss what the quality of health care is and how to measure it. We also introduce organizations that work on the quality of health care. We further review the effect of financial incentive -- different payment methods -- on the quality of health care. Finally, we examine the association between the quality of health care in hospitals (which is separated into two parts: process performance and outcome), hospital size, and the amount of Medicare payment to the hospitals. We found that the bigger hospitals indeed had better performance on care processes, but the effect on outcome (risk-adjusted 30-day mortality rates) varied from one medical condition to another. The composition quality scores had a modest effect on risk-adjusted 30-day mortality; hospitals with higher scores had lower mortality. The median Medicare payment for hospitals had no effect on risk-adjusted 30-day mortality rates in hospitals and composition quality scores of hospitals, except for the composition quality scores for heart attack patients.;Our findings revealed that key performance measures can partially reflect outcomes in hospitals. It indicated the effort of government and the organizations concerned with quality of health care issues is useful but there is still room for improvement.