One of the most basic problems in the American health care system is the lack of public information about the quality and cost of services provided by hospitals and other health care providers.

LIUNA General
and LHSFNA Labor
Armand E. Sabitoni

“Hospitals deliberately guard any data they collect regarding illness or deaths that occur as a result of their negligence or lack of proper care,” says LIUNA General Secretary Treasurer and LHSFNA Labor C0-Chairman Armand E. Sabitoni.  “This makes it difficult for our health and welfare funds, as well as any other consumer watch dog groups, to evaluate and compare the quality of care in a certain geographical area. That is why we are fighting for more transparency as an issue of public health.”

Is It a Heart Attack?

Heart disease is the number one killer of both women and men, and it’s important for everyone to know the warning signs of a heart attack. Although many people have the classic, chest-gripping pain often associated with a heart attack, there are a number of other symptoms. Women often experience different warning signs than men. Below are some common warning signs:

Chest discomfort. Most heart attacks involve discomfort in the center of the chest that lasts for more than a few minutes. It may go away and come back. The discomfort can feel like uncomfortable pressure, squeezing, fullness or pain.

Discomfort in other areas of the upper body. Can include pain or discomfort in one or both arms, the back, neck, jaw or stomach. You should be especially alert if these symptoms occur with heavier activity, like going upstairs.

Shortness of breath. Often comes along with chest discomfort. But it also can occur before chest discomfort.

Other symptoms. May include breaking out in a cold sweat, nausea or light-headedness. Women are more likely to experience these symptoms, as well as abdominal pain, weakness and fatigue. Minutes matter, and often people wait too long before seeking help. Call 911 immediately if you think you are having a heart attack.

Source: New England Laborers’ Health and Safety Fund.

If Americans are going to become better health care consumers, they need quality and cost data. But, if hospitals insist on keeping their secrets, how can the information be gathered and shared? Government intervention seems the only way, and in recent months, the first signs of progress are in evidence.

Last year, Pennsylvania became the first and only state so far (other states are considering similar legislation) to require insurers to report the amounts paid to various hospitals for heart bypass surgery, and in June, the first round of data was released. The Pennsylvania Health Care Cost Containment Council (PHC4) analysis found that among the state’s 60 hospitals that perform the operation, the best-paid hospitals received an average of nearly $100,000 for their work while the least-paid got less than $20,000. Yet, at both extremes, the length of stay in the hospital and the rate of death during care were comparable.

“These data just scratch the surface, but they confirm the growing consensus that in health care you just don’t get what you pay for,” says Sabitoni. “Our funds can pay relatively little or a lot, but the quality of care appears unrelated to the cost. We urge our funds in all states to join and support efforts to shed more light on provider costs and the quality of their services.”

Secretary of Health and Human Services (HHS) Michael O. Leavitt has spoken often about this discrepancy and his agency’s efforts to spur more transparency and accountability in the health care market. As the nation’s single biggest purchaser of health care services – for the federal Medicare and Medicaid programs – HHS has an immense stake in getting the most for each dollar of government expenditure.

In June, after more than a decade of restraint, HHS stepped back into the arena of health care accountability when it released a comparative study of hospital cardiac care and created a new U.S. government website – – to publicize the information. Speaking to reporters, Leavitt said, “This is a glimpse into the future.” Drawing an analogy from auto racing and comparing this report to the Formula One race car he would like to have, he explained, “What we’re developing today is a go-cart. It will get nothing but better as time goes on.”

Indeed, the HHS study is little more than a glimpse, but it does restore a role for government in the health care market that had been abandoned since the early 1990s.

Though it had never associated cost with quality of care, the government published individual hospital mortality data during the 1980s, after the New York Times pursued the information. However, hospitals consistently claimed that the publication was unfair because the government made no effort to differentiate among patients based on the state of their health when they entered the various hospitals. The facilities claimed that the highest death rates were at hospitals that accepted the poorest and sickest patients. As a result of these claims, the Clinton administration decided to quit releasing the data.

In the U.S., however, most health insurance is paid for by employers – or, as in the case of the Laborers, through joint labor-management funds – who want and need more information about both cost and quality of care to make informed purchase decisions. As health costs have skyrocketed over the last decade, business groups have pressed the government to renew publication of hospital performance data.

Almost 5,000 hospitals are included in the HHS site’s cardiac analysis, but little differentiation is revealed. For instance, only 17 were rated above average and seven below average in heart attack treatment. The other 4,900-plus were rated average. In treatment for heart failure, 38 were above and 35 below average.

Despite the lack of differentiation, experts generally applauded the HHS effort. While the data will not help consumers in choosing one hospital over another, they will spur hospitals with poor records to examine their practice and improve their procedures. Also, HHS officials indicated that more gradations of performance may be added in coming years, adding pressure for change to a larger number of facilities.

Another shortcoming is the scope of the data presented – just heart attack and heart failure responses. Next year, pneumonia data will be added. Patient satisfaction surveys may also be added to the website in years to come.

Though hospitals continue to cast doubt on the analysis, HHS officials said that the data is now “risk-adjusted” to account for health differences among patients at the time of admittance. However, experts agree that making such adjustments is difficult and will require refinement as the system develops.

“The information on the new HHS site isn’t designed to help you make decisions in emergency situations,” says Sabitoni. “Generally, if you’re having a heart attack, you need to get to the nearest hospital as quickly as possible. You can’t worry about its rating. Still, the nation needs more accountability in our health care system. We welcome the government’s pursuit and publication of cost and quality care information at both the state and federal levels, but we’ve got a long way to go.  With the help of the LHSFNA, our health and welfare funds will keep pushing for the information they need to make sure that LIUNA members get top quality care at the best possible price.”

More information about health care cost coalitions is available from the LHSFNA Health Promotion Division. The causes of soaring hospital costs as well as particular coalition efforts to combat them are examined in LIFELINES, Winter, 2006.

[Steve Clark]