The researchers say that to help reduce complications, insurers not only should quit paying for substandard care, but also should reward excellent care with bonuses. In addition, hospitals should be required to disclose their complication rates, because patients will shun those with high rates and force those hospitals to improve or shut down.

Dr. Barry Rosenberg, an author and a managing director of Boston Consulting, said the study came about because his firm was working with Texas Health Resources to find ways to reduce its hospitals’ surgical complication rates, which, at 5.3 percent, were in line with those reported by similar hospitals. Part of that work involved analyzing the costs, and he said the team was stunned to realize that lowering the complication rates would actually cost the hospital money.

“We said, ‘Whoa, we’re working our tails off trying to lower complications, and the prize we’re going to get is a reduction in profits,’ ” Dr. Rosenberg said in an interview.

The authors focused on one particular figure, called the contribution margin, which is an important measure of a hospital’s income and ability to cover its costs. They said that when complications occurred, this measure tripled for patients with private insurance and doubled for those on Medicare.

Dr. Mark C. Lester, a study author and the executive vice president of Texas Health Resources, said its hospitals had begun to use a checklist system to help prevent complications. Dr. Atul A. Gawande, a Harvard surgeon who is a pioneer in using checklists and who took part in the Texas study, helped develop the system. Surgical checklists involve deceptively simple-sounding practices like double-checking the patient’s identification and what part of the body is being operated on, and making sure that drug allergies have been noted and proper medications given.

Dr. Lester said it was not clear how low the complication rate could or should go. Zero would be great, but was not realistic, he said.

As to whether the hospital would lose money if more patients needed less care and went home sooner after surgery, Dr. Lester said, “to us that doesn’t have an impact.”