To the Editor: In their Special Communication, Drs Porter and Teisberg1 make a number of reasonable suggestions for how to improve the quality of health care. However, I consider their fundamental assumption (better quality of care reduces health care costs) questionable. Many health care interventions increase health care costs.2 This means that improving the quality of care by reducing an underuse of health care interventions will in general increase rather than decrease costs. Given that US adults receive only 55% of recommended care3 and that each unit reduction of a quality deficit results in an overproportional increase of costs,4 vast resources may be needed to achieve high quality of care.
Even if the target of quality improvement activities is the reduction of overuse and misuse, it is not clear that cost savings will result. Quality improvement activities themselves incur costs, and reducing errors or complications might increase costs in the long term because people live longer. For example, referral of hip fracture surgeries to high-volume hospitals in Germany does not lead to savings in the long run despite fewer deaths and complications in the short term.5
Financial Disclosures: None reported.
Country-Specific Mortality and Growth Failure in Infancy and Yound Children and Association With Material Stature
Use interactive graphics and maps to view and sort country-specific infant and early dhildhood mortality and growth failure data and their association with maternal
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