The Nation's Health Care System - Access Does Not Necessarily Ensure Quality

Even insured Americans who live in metropolitan areas with an ample supply of available health care facilities and providers receive, on average, just half of the recommended screenings and other preventive health care services. A Rand Corporation study, funded by the Robert Wood Johnson Foundation and grants from the Veterans Affairs Health Services, found inadequate care in every one of the twelve metropolitan areas surveyed. Researchers Eve A. Kerr and her colleagues observed that "health care quality falls far short of its potential nationally" in "Profiling the Quality of Care in Twelve Communities: Results from the CQI Study" (Health Affairs vol. 23, no. 3, May/June 2004).

The investigators looked at interviews and medical records of 7,000 adults and analyzed them using 439 measures of quality for thirty medical conditions including asthma, diabetes, heart disease, and hypertension as well as preventive care. They found that just half of all heart attack patients receive timely treatment with two medications (aspirin and beta blockers) that have been proven to save lives. Of persons with chronic diseases, those with diabetes fared worst, failing to receive adequate treatment and counseling to prevent or delay the serious consequences of the disease. Some preventive services, such as immunizations and blood pressure screenings, were performed much more often than others, such as counseling about and screening for sexually transmitted diseases and counseling about substance abuse.

Although access problems are much greater for persons who are uninsured and those who live in rural or otherwise underserved areas, this research confirmed that ability to pay for needed medical care and availability of health services were necessary but not sufficient to guarantee access to quality care. The discrepancy between the health care that Americans should receive and the care that they actually receive is even more striking in view of the fact that the United states spends more on health care—an estimated $1.5 trillion each year—than any other nation in the world.