1. Because of possible complications at delivery, Mrs. T. is told by her
   doctor that she will have to give birth at South General Hospital.
   When Mrs. T. tells her friends what her doctor said, they are
   appalled and urge her to do all she can to go to Community Hospital
   instead. The friends draw sharp contrasts between the two
   hospitals. Community has quiet birthing rooms and was recently
   redecorated, and each patient is assigned a specific nurse. Because
   the nurses work 12-hour shifts, most women who deliver at the
   hospital have just one or two nurses attending to them. At South
   General, deliveries take place in ordinary, noisy hospital rooms.
   Staff tend to be busy and are not especially friendly, and women in
   labor are typically under the care of multiple nurses. Who is right?
   Is South General a bad place to have a baby? Should Mrs. T. go to
   Community instead? Explain the reasoning behind your answer.

2. Describe three instances in which outcomes would not be a good measure of healthcare quality, and explain why.
3. Do you agree that care can be both high quality and inefficient? Why or why not?
4. Your friend Alicia is puzzled by an observation she read in a
newspaper column:
Research by John Wennberg and colleagues at Dartmouth Medical School suggest
that if everyone in America went to Mayo Clinic for care, our annual healthcare bill
would be 25 percent lower (more than $500 billion in savings!), and the average
quality of care would improve.
It makes sense to Alicia that, given Mayo’s reputation, the average
quality of care would improve if everyone received care of the
caliber Mayo provides. The part she doesn’t understand is how
providing Mayo Clinic–level care could possibly reduce annual
expenditures on healthcare by 25 percent. Wouldn’t it cost more
to provide better care? If anything, Alicia believes, providing
everyone Mayo Clinic–level care would increase expenditures by
25 percent. Did the columnist get the facts wrong? Address Alicia’s
puzzlement with a clear, complete explanation.