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Evidence from a systematic review1 conducted to determine the association between healthcare quality and healthcare costs provided inconclusive support for a direct association between the 2 variables. The Robert Wood Johnson Foundation funded an electronic literature search of United States-based studies published between 1990 and 2012. PubMed, EconLit, and EMBASE databases were examined. Titles, abstracts, and a full-text review were used to identify studies to be examined.


Thirty-four percent of the studies conclusively showed that higher costs were associated with higher quality of care. However, 18% of the studies illustrated either a negative or mixed-negative association between the variables. Twenty-two percent of the studies reported no difference, an imprecise or indeterminate association, or a mixed association. Based upon the criteria evaluated in the 61 studies examined, the associations supported were of low to moderate clinical significance. The research group noted that study methods and measures were heterogeneous, thus further compounding difficulty of accurately evaluating the association.


Thus, evidence in the literature reviewed illustrating a direct association between healthcare care costs and quality proved to be inconsistent. In addition, the association between the variables was small to moderate, whether positive or negative.


This study serves to bring our attention again to the ideas that quality of healthcare is associated with numerous variables other than costs. As nurses, we know this. We need to express this to more and more patients, students, educators, and nurses. The study provides reassurance related to healthcare in our economically challenging environment.


1. Hussey P, Werheimer S, Hehrotra A. The association between health care quality and cost: a systematic review. Ann Intern Med. January 2013;158(1):27-34. Available at Accessed February 19, 2013. [Context Link]


Source: Nursing Management eNews. More money, more care? January 10, 2013.


Submitted by: Robin E. Pattillo, PhD, RN, CNL, News Editor at