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Redefining Competition In Health Care

Summative evaluation focusses on programs that are already underway or completed. It investigates the effects of the program, both intended and unintended. It seeks to answer the questions “Did the program make a difference?”(impact evaluation) and “Did the program meet its stated goals and objectives?”(outcome evaluation). In its most rigorous form the design of an outcome evaluation can become very complex in order to rule out any other plausible explanations for the results. Outcome evaluation can assess both short term outcomes, immedi- ate changes in individuals or participants (such as participation rates, awareness, knowledge, or behaviour) and long term outcomes (some- times referred to as impact evaluation) which look at the. | Harvard Business Review www.hbr.org The wrong kinds of competition have made a mess of the American health care system. The right kinds of competition can straighten it out. Redefining Competition in Health Care by Michael E. Porter and Elizabeth Olmsted Teisberg Reprint R0406D The wrong kinds of competition have made a mess of the American health care system. The right kinds of competition can straighten it out. Redefining Competition in Health Care by Michael E. Porter and Elizabeth Olmsted Teisberg COPYRIGHT 2004 HARVARD BUSINESS SCHOOL PUBLISHING CORPORATION. ALL RIGHTS RESERVED. The U.S. health care system has registered unsatisfactory performance in both costs and quality over many years. While this might be expected in a state-controlled sector it is nearly unimaginable in a competitive mar-ket and in the United States health care is largely private and subject to more competition than virtually anyplace else in the world. In healthy competition relentless improvements in processes and methods drive down costs. Product and service quality rise steadily. Innovation leads to new and better approaches which diffuse widely and rapidly. Uncompetitive providers are restructured or go out of business. Value-adjusted prices fall and the market expands. This is the trajectory common to all well-functioning industries com-puters mobile communications banking and many others. Health care could not be more different. Costs are high and rising despite efforts to reduce them and these rising costs cannot be explained by improvements in quality. Quite the opposite Medical services are restricted or ra tioned many patients receive care that lags currently accepted procedures or standards and high rates of preventable medical error persist. There are wide and inexplicable differences in costs and quality among providers and across geographic areas. Moreover the differences in quality of care last for long periods because the diffusion of best practices is extraordinarily .