Initiatives for improving the quality of health care are now focused on stemming the underuse of "effective care"--therapy viewed as medically necessary care on the basis of clinical outcome evidence. But only a small proportion of the health care dollar is influenced by effective care. Most of the spending, at least regarding Medicare, is in two other categories. "Preference-sensitive care," in which treatment options involve tradeoffs that should be based on the patient's own values, tends not to be underused but misused. And "supply-sensitive care," in which the supply of resources governs the frequency of their use, is overused, particularly in the management of chronic illness. Hospital-specific measures that profile performance--such as the average number of days spent in the hospital during the last six months of life and physician labor inputs over that time--could help identify more efficient providers.
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