Articles

(April 2006) Pennsylvania has health care institutions that are among the best in the world. Academic health centers in the state are pioneering new research on treatments and cures to advance modern medicine and enhance quality of care. But there’s a recurring question about health care in Pennsylvania. What can be done to ensure quality health care for all Pennsylvanians, and what is the government’s role?

Government already is involved in many ways. As an overseer, state government sets regulations and publishes information about health care quality, and it works to assure the qualifications of those who are part of the system. As a funder – through a variety of revenue streams such as tobacco settlement research funds, medical education support dollars, and state cancer centers funding – state government supports the activities of teaching and research institutions that are an important investment in health care quality and crucial to Pennsylvania’s overall economic health and vitality.

Still, whether state government has hit the right combination of regulation, incentives, and information – for health care providers and the consumer – is an on-going question.

What impacts health care quality in Pennsylvania?

Many factors that aren’t really under governmental control – and some that are – have an impact on quality. Healthcare quality, of course, really can’t be separated from issues of access and cost. A shortage of qualified nurses and other health care workers impacts health care quality in hospitals and other health care settings across Pennsylvania. People who live many miles from the nearest specialist, or even family doctor, or those with limited transportation options don’t have advantages enjoyed by those for whom the appropriate services are easily accessible.

A November 2001 state House of Representatives report concluded serious shortages exist in health care personnel “that threaten the very fabric of the state’s health care system. These shortages exist in rural, suburban, and urban areas.” Certainly those who’ve had to wait hours in an emergency room for routine care because they can’t get to or don’t have a primary care physician would agree that the experience simply doesn’t compare with being able to schedule a timely appointment with the family doctor in his or her office.

Patient safety, a core component of quality health care, primarily is dependent on health care practices that range from workers washing their hands between patient visits to systems that aggressively identify and eliminate the causes of outbreaks of infections in hospitals. Hospitals and doctors increasingly are re-training their employees and using technology to reduce errors such as in distribution of medicine. And private sector efforts, such as the Pittsburgh Regional Healthcare Initiative, have worked to improve safety and quality in healthcare delivery in their areas.
Consumers also have a responsibility for their own actions that affect the safety and effectiveness of their healthcare. But the question remains: even though there are so many players with varying levels of responsibility and accountability, what role should state government play in ensuring quality?

What is state government’s role on health care quality?

The 2002 “MCARE Act” made Pennsylvania a leader in the pursuit of patient safety. Pennsylvania was the first state in the nation to require reporting of adverse events and near misses. To help reduce the number of medical malpractice incidents and improve safety for all patients, the MCARE act created a Patient Safety Authority to review medical errors and make recommendations for improving patient safety. Medical facilities must notify patients affected by a serious event, in writing, within 7 days. Medical facilities also are required to develop and implement patient safety plans.

The state plays several other roles to help ensure health care quality. As regulators, the state Health and Insurance departments are charged with monitoring insurers and providers, including managed care providers. The Pennsylvania Health Care Cost Containment Council (PHC4) provides information on the most efficient health care providers to individual consumers and group purchasers. The Department of Health promotes disease prevention activities.

Although there’s lots of attention focused on rising health care costs and more limited access to health care, Pennsylvania’s policymakers also face issues closely related to health care quality. These include: 

• Assuring that the state’s regulatory and monitoring framework is sufficient. 
• Maintaining and strengthening Pennsylvania’s strong health and biomedical research infrastructure. 
• Addressing shortages of qualified health professionals. 
• Giving the consumer sufficient information on indicators of provider quality. 
• Enhancing the state’s public health infrastructure and ensuring its preparedness in the event of a public health emergency, such as a bioterrorist attack.

Health care – availability, affordability, and overall quality – is on the minds of patients, medical professionals, employers, insurers and more. Moving forward, how Pennsylvania’s policymakers respond will be a contributing factor in determining Pennsylvanians’ overall quality of life.