Map of life expectancy at birth from Global Education Project.

Wednesday, June 17, 2009

We continue to fail

Part of the background noise to the health care reform debate, issuing principally from the drug and medical device companies and hospital industry and health insurance industry and AMA -- that is to say the Medical-Industrial Complex -- and its allies in the Republican Party and a good chunk of the Democratic Party -- is the claim that the United States has the world's highest quality, most technologically advanced health care; that most people are well-served by the current system; and that proposed reforms such as Comparative Effectiveness Research, a public insurance option, and cost containment, will take something away from people. (Sorry for that Faulknerian sentence.)

Sorry, but the truth is otherwise. We, in fact, suck. Politicians and pundits could easily inform themselves by reading AHRQ's latest reports on health care quality and disparities. Now, there are weaknesses in the data available to measure quality, but based on what we've got:

Overall, despite promising improvement in select areas, the health care system is not achieving the more substantial strides needed to close the gap or "quality chasm" that persists. Despite efforts to transform the U.S. health care system to focus on effective preventive and chronic illness care, it continues to perform better when delivering diagnostic, therapeutic, or rehabilitative care in response to acute medical problems. This system achieves higher performance on measures related to acute treatment, such as that for heart attacks, as opposed to prevention and anticipatory management of chronic illnesses, such as cancer screening and diabetes management.

Overall, progress on quality measures has been exceedingly slow -- a median of 1.8% per year for "core measures," and 1.4% per year for all measures. 31% of measures showed no improvement at all. Examples of what this means specifically include an increase in recent years in the percentage of patients with central lines who got blooodstream infections, from 1.7% to 2.8%. That's a really bad thing to have happen to you. On the whole, hospital acquired infections continue to be a growing problem.

And, as for disparities:

Both categories of measures, quality of care and access to care, show that disparities persist for all populations. Measures of quality include effectiveness (the percentage of patients with a disease or condition who get recommended care), patient safety, and timeliness. The NHDR includes the added dimension of access to care to measure differences in health insurance coverage, utilization of general health services, and other barriers to care. Below are figures that illustrate for each population how disparities in quality and access have changed in the past 5 years.

[F]or Blacks, Asians, American Indians/Alaska Natives (AI/ANs), Hispanics, and poor people, at least 60% of measures of quality of care are not improving (either stayed the same or worsened).

So no, we don't have high quality care and we don't have equity and justice either. This is really basic, and its incontrovertible. In the next post, I will discuss why less is more -- why an essential step toward improving quality and equity is to produce less medical intervention. Ridiculous frames like "the European medical scarcity model" need to be purged from our discourse. We're drowining in not just unnecessary, but downright harmful, medical intervention.


roger said...

there you go again. using reality based evidence. the reality of money influence trumps actual medical data. our congress is corrupt. even ron wyden won't mention a public option for health care.

whisker said...

The other day I got in a discussion with a gentleman who believed that America does have the best health care system in the world. The logistics of the discussion are irrelevant but Roger summed it up quite well with people have a lack of reality based evidence perhaps caused by our media. Anyway what are the worlds best health care systems?