Choosing a Hospital: How Do They Differ?

Think all hospitals provide approximately the same level of service and that your outcome will be the same regardless of which hospital you use? Not true! The Mercer HCIA study of the top 100 hospitals in the country suggests that hospitals differ widely in performance, just like other service organizations. Mortality, patient complications, length of stay, cost per discharge, and profitability all vary even after adjusting for severity of the cases treated.

Although hospitals vary in performance, the problem for the average consumer is identifying the differences that really matter. The real questions are how do hospitals differ in ways important to you, and how can you compare hospital performance?

The most important consideration for you, the patient or parent, is how well they will take care of you or your child. As with choosing a doctor, experience with conditions similar to yours is probably the most important factor. You want a hospital that deals with your medical condition often enough to know what should be done. Experience also helps physicians recognize their limitations. For pregnancy, you want to know how many normal and high-risk deliveries occur at a hospital. For problems with your infant, you want to know how often the hospital treats sick infants and if it has a newborn intensive care unit (NICU).

The Importance of Volume

Recent studies show that receiving angioplasty from an experienced physician and hospital team lowers the risk of death and complications. Another study looked at mortality among preterm infants born in New York City; these infants had a 24 percent higher mortality rate if they were not born at tertiary centers, which are the best equipped and most experienced at dealing with sick, premature infants. The less sophisticated centers would not be expected to deal with very preterm infants regularly.

Similarly, another study showed that infants not born in a tertiary center had a higher mortality and more complications than those who were. There have been conflicting studies about this issue, and many other variables influence mortality at a particular hospital. However, a hospital's experience in dealing with preterm or sick, full-term infants makes a difference in the quality of care they can provide for those infants.