Spending More But Getting Less

Posted on | April 30, 2008 | Comments Off on Spending More But Getting Less

Why can’t the increases in health care quality keep up with the increases in cost?

The quality of health care in the United States improved by an average of 2.3% per year between 1994 and 2005, reports the Agency for Healthcare Research and Quality, but in the same period health care expenditures rose by a 6.7% annual rate, according to the Centers for Medicare & Medicaid Services.

Why the difference? That’s what both AHRQ and CMS, in their focus on quality, are trying to determine. Worldwide, the U.S. has the highest health care cost per capita but ranks in the middle among developed countries in quality of care. There’s something wrong with that picture, isn’t there?

Let’s look at a couple of important positives: There have been improvements (5.6%) in the care of heart disease patients, in several ways, including appropriate followup care to patients who have suffered heart attacks, better testing, and counseling to quit smoking. The disparity between Hispanics and whites in getting delayed or no care for illness has decreased; Hispanics are doing better. Same is true of black children receiving appropriate vaccinations; the gap with white children has diminished.

Now more than one negative: Measurements of patient safety – for the most part a hospital measure – showed only a 1% improvement, an unacceptable level regarding prevention of falls, post-surgery complications, and harmful drug actions and interactions. Black children under 18 are still 3.8 times more likely than whites to be hospitalized for asthma, indicating a lack of preventive care. New AIDS cases are 3.5 times more likely among Hispanics than whites. Pregnant Native Americans are 2.1 times less likely to receive first trimester prenatal care.

Some of the reasons as we examine the problem:

1. Inadequate health insurance coverage that leaves over 40 million Americans to seek high-cost or charity care – or get no care at all, particularly preventive care.

2. Fee for service medical care, which forces physicians and other healthcare providers to spend their time dealing with patient problems that pay, and take little time to handle. It’s much easier to write a prescription than to take time to counsel a diabetic or hypertensive patient.

3. Sedentary, high-calorie lifestyle of most Americans, that makes us prone to multiple chronic diseases such as heart disease, diabetes, obesity, depression and hypertension. These habits are hard to change, despite efforts by public health officials – and higher gasoline prices!

We’d like to hear from you about other causes of the disparity between healthcare quality and cost – and to hear your suggestions for change. Americans should be living longer, healthier lives, without wide disparities between cultures!