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Too good to last: did Cleveland Health Quality Choice leave a legacy and lessons to be learned?
  1. D Neuhauser1,
  2. D L Harper2
  1. 1Epidemiology and Biostatistics, Medical School, Case Western Reserve University, Cleveland, USA
  2. 2Florida Institute of Technology, Melbourne, Florida, USA
  1. Correspondence to:
 D Neuhauser, Epidemiology and Biostatistics, Medical School, Case Western Reserve University, Cleveland, OH 44106–4945, USA;

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This is the story of the martyrdom of an idea, an organization that embodied that idea, its director, and a group of staff and volunteers committed to making it work. The idea is that the comparable outcomes of hospital care should be measured and publicly reported so people could choose high quality care. This idea was embodied in a small organization called Greater Cleveland Health Quality Choice (GCHQC) and its director Dwain Harper.


In the 1980s large and small businesses in Cleveland, Ohio paying for health insurance for their employees and families were experiencing annual double digit inflation for their costs for employee health care in the 30 or more hospitals in the area.* Like sensible businessmen and women, they decided to select those hospitals that had low costs and could demonstrate high quality. They implemented strategies to encourage their employees to use them. In spite of claims to the contrary, Cleveland employers did not want to purchase just the least expensive hospital care; they wanted to purchase value, a functional balance between low cost and high quality. Quality should matter and employers would measure it and make the results publicly available.


Collectively, in the 1980s, employers had enough power in this marketplace (Cleveland) to demand that hospitals submit data amenable to reporting standardized quality measures which would be made public so people could make informed decisions and choose the hospital having the best value. Physicians and hospitals found it wise to participate in this initiative and assumed leadership roles in the program's creation and evolution. Businesses saw this as a desirable advantage and partnered with providers in this unique program.

By 1990, standardized data were being collected independently which enabled reporting of severity adjusted mortality rates, cesarean section deliveries, vaginal birth after …

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  • * For those not familiar with the economics of health care in the USA it is important to know that, for working age employees and their families, health insurance is paid through their employer. Because the companies pay, they see a clear need to control these costs and keep their employees content. The hospitals are independent corporations and free to negotiate over the price of care with each payer. The relative bargaining power between these two parties varies.