Evidence map›Paper›PMID 23277898›Full record

SynthesisAnnals of internal medicine2013

The association between health care quality and cost: a systematic review.

Peter S Hussey, Samuel Wertheimer, Ateev Mehrotra

Abstract readSystematic Review
PubMed Full text at PMC Publisher
In one paragraph

Synthesis in Annals of internal medicine, 2013. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 113 papers, 2 of them syntheses that pooled it.

0numbers the graph read from it
0cells of the map it votes in
113citing papers in PubMed, 2 pooled it
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

113 citing papers in PubMed, 2 syntheses or guidelines pooled it.

  1. Pooled it
  2. Pooled it
  3. Observational
  4. Quantitative analysis of trends and inequalities in disease burden and care quality of gynecological cancers, 1990-2021.European journal of cancer prevention : the official journal of the European Cancer Prevention Organisation (ECP) · 2026
    Article
  5. Observational
  6. Article
  7. Article
  8. Article
  9. Review
  10. Article
  11. Article
  12. Socioeconomic Disparities in Patients Undergoing Alcohol Septal Ablation for Hypertrophic Cardiomyopathy.Journal of the Society for Cardiovascular Angiography & Interventions · 2025
    Article
  13. Article
  14. Article
  15. Article
  16. Article
  17. Article
  18. Review
  19. Article
  20. Article

53 more citing papers are in PubMed but not listed here.

4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

3 authors.

Peter S HusseyRAND Health, Arlington, VA 22202, USA. peter_hussey@rand.org
Samuel Wertheimer
Ateev Mehrotra

Funding

University of Pittsburgh Clinical and Translational Science InstitutionKL2RR024154 · NCRR · UNIVERSITY OF PITTSBURGH AT PITTSBURGH · PI REIS, STEVEN E · 2006 to 2011
$22.2M
NCRR NIH HHS KL2 RR024154
6 · The paper itself

Abstract

backgroundAlthough there is broad policy consensus that both cost containment and quality improvement are critical, the association between costs and quality is poorly understood. PURPOSE: To systematically review evidence of the association between health care quality and cost. DATA SOURCES: Electronic literature search of PubMed, EconLit, and EMBASE databases for U.S.-based studies published between 1990 and 2012. STUDY SELECTION: Title, abstract, and full-text review to identify relevant studies. DATA EXTRACTION: Two reviewers independently abstracted data with differences reconciled by consensus. Studies were categorized by level of analysis, type of quality measure, type of cost measure, and method of addressing confounders. DATA SYNTHESIS: Of 61 included studies, 21 (34%) reported a positive or mixed-positive association (higher cost associated with higher quality); 18 (30%) reported a negative or mixed-negative association; and 22 (36%) reported no difference, an imprecise or indeterminate association, or a mixed association. The associations were of low to moderate clinical significance in many studies. Of 9 studies using instrumental variables analysis to address confounding by unobserved patient health status, 7 (78%) reported a positive association, but other characteristics of these studies may have affected their findings. LIMITATIONS: Studies used widely heterogeneous methods and measures. The review is limited by the quality of underlying studies.

conclusionEvidence of the direction of association between health care cost and quality is inconsistent. Most studies have found that the association between cost and quality is small to moderate, regardless of whether the direction is positive or negative. Future studies should focus on what types of spending are most effective in improving quality and what types of spending represent waste. PRIMARY FUNDING SOURCE: Robert Wood Johnson Foundation.

Indexed as

Health Care CostsConfounding Factors, EpidemiologicCost ControlHealth PolicyQuality ImprovementQuality of Health CareUnited States

Identifiers

PMID23277898
PMCPMC4863949

What OpenQuestion holds

Textmetadata
LicenceTDM
Read underepoch 390

Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.