THE POLICY IMPLICATIONS OF USING HOSPITAL AND PHYSICIAN VOLUMES AS INDICATORS OF QUALITY OF CARE IN A CHANGING HEALTH-CARE ENVIRONMENT

There is growing interest in the quality of health care and in using q uality measures to direct patients to hospitals and providers offering high quality, low cost health care, The dilemma is that, while there is an increasing need for quality indicators as a result of a changing health care environment, this changing environment has important impl ications for the use of some of these measures, Since the 1970s, a gro wing body of research in the U.S. has addressed the empirical relation ship between the number of patients with a specific diagnosis of surgi cal procedure and their outcomes after treatment in a particular hospi tal or by a particular physician (''volume-outcome'' studies), In this paper, we examine the policy implications of using hospital and physi cian volume information as an ''indicator'' of quality in a rapidly ch anging health care environment with new players and new incentives, We begin by describing the evolution of the use of volumes within both r egulatory and market-oriented contexts in the U.S. We then discuss pol icy considerations and cautions in using volumes, along with suggestio ns for future research, Our purpose is to point out potential problems and clarify confusions about the use of volumes, so that policymakers and practitioners can be sensitive to the potential minefields they a re traversing. (C) 1997 Elsevier Science Ltd.