The No Child Left Behind legislation worked so well (ha ha) that the Bush administration is advocating similar standards-based regulation of medical care in the US.

Now, that may sound fine and all and pushing for electronic records is a definite good idea, but I'd direct you to read our post on a recent NEJM paper describing the effect a similar program had in Britain. While they aren't talking about rewards based on provision of care, this type of monitoring of care will result in the same effects as observed in the British system. Namely, doctors that serve more patients, poorer patients, less educated patients, older patients, etc., end up penalized while doctors seeing the educated, rich, young patients are not. Further, the doctors that did the best were the ones that inflated their stats by manipulating the reporting system.

Wait a minute, what does that sound like again? Oh yeah, No Child Left Behind.

Face it, some populations are harder to provide services for, and all these standards-based reforms do are penalize well-meaning people facing a tough situation.

The solution to providing medical care isn't looking over doctors shoulders and penalizing them for seeing tough patients (or conversely, encouraging them to falsify records to make their stats better). Standards-based reforms aren't reforms at all, as we've mentioned previously, they're a cynical effort to make it appear as though reform has occurred. Inevitably, when such systems are put in place the learning curve of the affected professionals makes it appear as though dramatic improvement occurs in the first few years. Then in subsequent years the schools, hospitals whatever, learn to deal with the testing or reporting in such a way that they don't get nailed (teachers teach to the test for instance) and politicians get to claim they're responsible for huge improvements in whatever was monitored when it really is just a flaw in measurement.

Anyway, nice to see the Bush administration stretching their incompetent management in yet another direction.