Hillary targets health care quality

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LEBANON, N.H. (AP) — Hillary Rodham Clinton promised yesterday that as president she would improve health care quality by raising standards for providers, educating patients and requiring insurers to reward innovation.

While rivals Sen. Barack Obama of Illinois and former Sen. John Edwards of North Carolina have proposed detailed health care overhaul plans, Mrs. Clinton is taking an incremental approach. The New York Democrat started with a speech in June on reducing costs, followed by yesterday's address on quality, and she will outline her plan for universal health care coverage next month.

"My order here is deliberate," she said. "In order to forge a consensus on universal health care, we need to assure people that they will get the quality they expect at a cost they can afford.

"Too often, and in too many places, our health care system hurts us instead of helps us," Mrs. Clinton said at Dartmouth-Hitchcock Medical Center. "It hurts doctors, who aren't rewarded for providing the best care and are often punished for it financially. It hurts nurses, who are asked to work longer hours, caring for more patients with fewer resources. And it hurts patients, who are forced to make complicated medical decisions without basic information about their conditions and options."

To improve quality, she said, she would promote physician certification programs that help doctors keep up with the latest advancements, increasing Medicare reimbursements for doctors who participate in them. Nursing care would get a boost in the form of $300 million to expand enrollment in nursing schools, create mentoring programs for recent graduates and recruit more minorities into the profession.

"The nursing shortage has become a nursing crisis, and that means it is a crisis for everyone," Mrs. Clinton said. "Our nurses are truly the eyes and ears, and in many ways the heart and soul of our health care system. When we've got fewer nurses working longer hours and serving more patients, the result can be worse outcomes."

Patients, too, can play a role in improving the quality of health care they receive, she said, if they are given more information about their treatment options. She praised Dartmouth-Hitchcock's Center for Shared Decision Making, saying she would like to see similar programs nationwide.

Mrs. Clinton also called for overhauling a reimbursement system that she said often punishes doctors for doing the right thing: spending time with patients or working with their colleagues to take a collaborative approach. She proposes higher payments to providers who use teams to provide coordinated care and ending payments for preventable infections and injuries sustained during hospital stays.

"We need a system that encourages instead of discourages quality," she said.