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Most Americans Getting Substandard Health Care

Overall, those surveyed got only 54.9 percent of recommended care, report shows

WEDNESDAY, March 15, 2006 (HealthDay News) -- All Americans are at risk for receiving substandard health care, regardless of their gender, race, income or even insurance status, a new study shows.

And while disparities do exist between groups, they pale in comparison to a more general treatment gap: Overall, those surveyed got 54.9 percent of the care experts recommend for their condition.

"There's no question that disparities exist, but the big variations are not between groups, but between what people are getting and what people should be getting," said study author Dr. Steven M. Asch, of Rand Health. "Everyone, men and women, rich and poor, insured and uninsured, is at risk. No matter who you are, it's almost a flip of the coin as to whether you get the care that experts want for you."

The findings, reported in the March 16 issue of the New England Journal of Medicine, are a clarion call for updating a fragmented health-care system and for making technology more available within this system, the researchers noted.

The study, conducted by Rand Health, is the third in a series on health-care quality in the United States. The two previous publications found that Americans receive only about half of recommended care, regardless of their geographical location.

Using both telephone interviews and reviews of patients' medical records, the authors of this study collected data on about 6,700 patients in 12 metropolitan areas who had received care between 1996 and 2000. Health care was assessed using 439 quality indicators for 30 acute and chronic conditions. The indicators had been validated by 36 specialists considered leaders in their field.

Two important notes: The researchers looked only at what happened during the visit, not at issues of access or at what happened after the patient left the office (for example, filling a prescription).

Among the study's other findings:

  • Women received more recommended care than men (56.6 percent vs. 52.3 percent).
  • Women were more likely than men to receive preventive care (58 vs. 50 percent) and chronic care (58 vs. 55 percent). But women were less likely than men to receive needed acute care (52 vs. 58 percent).
  • Generally, quality of care declined as people got older. People under the age of 31 received more recommended care than those over the age of 64 (57.5 percent vs. 52.1 percent).
  • Blacks (57.6 percent) and Hispanics (57.5 percent) got slightly more recommended care than whites (54.1 percent). It was not clear why this was so.
  • People with incomes above $50,000 received more recommended care than those with incomes of less than $15,000 (56.6 percent vs. 53.1 percent).
  • Insurance status had no effect on quality of care received.

Because the authors were not examining access to care, only the quality of care once accessed, it's possible that these figures are actually optimistic ones.

"If you take it all the way down the chain, it could actually be much worse," said Elizabeth A. McGlynn, senior author of the paper and an associate director of Rand Health. "In some ways, 55 percent is an overestimate of the chain of events leading to whether or not people's health is as good as it could be."

Increases and complications in what physicians need to know and need to do to adequately care for patients may explain why the numbers are so low, the authors speculated.

"There's been an explosion of medical knowledge, and of the possibilities of what can be done for you over the past five to 10 years," McGlynn said. Putting that all together is beyond what even the most facile human mind can handle.

But the technology to cope with this explosion is available, it's just underused in health care, Asch said.

"The system is not set up; information technology can make a difference," Asch said. "Another potential fix is transparency and feedback. Physicians and patients have little idea how often they are succeeding or failing because such information is pretty hard to get."

According to Asch, the Veterans Affairs system is already using upgraded information technology and "care has improved dramatically," to about two-thirds of veterans now receiving recommended care.

"We wouldn't tolerate this in almost any other sector of society," he continued. "We wouldn't tolerate it if a pilot had to memorize his preflight checklist before he flew cross country. It's a complicated thing to give medical care, and to do it right you need assistance."

More information

Visit the government's Agency for Healthcare Quality and Research for more on issues of medicine and quality.

SOURCES: March 15, 2006, teleconference with Steven M. Asch, M.D., Rand Health and Veterans Affairs, Greater Los Angeles Health Care System and the University of California, Los Angeles, and Elizabeth A. McGlynn, Ph.D., associate director, Rand Health; March 16, 2006, New England Journal of Medicine
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