More Care Doesn't Boost Patient Satisfaction

High-quality, carefully coordinated care should not be confused with delivery of more services, coauthor Dr. Goodman said.

“Unfortunately, I think we have very strong financial incentives that operate in many health systems for delivering higher quantity,” he said, noting that physicians are paid for independently delivering a particular service, not for coordination of care.

Some activities perpetuate the idea that more is better. Building more intensive care units and adding hospital capacity takes a huge amount of money that could be better spent on reforming organizations and creating stronger primary care-centered delivery systems, Dr. Goodman said.

He cited proposals by Dr. Elliott S. Fisher, a professor of medicine and community and family medicine at the Dartmouth Medical School, who advocates “the accountable care organization,” in which natural groupings of physicians in a hospital take responsibility for a given population and for measuring quality of care.

Research on this type of organization is ongoing, and data on the approach are anticipated soon, Dr. Goodman noted.