U.S. Health Care 'Mediocre,' Regardless of Race, Age, Economic Status, Study Says
U.S. residents receive appropriate medical care about 55% of the time -- regardless of race, income, education or health insurance status -- according to a study published on Thursday in the New England Journal of Medicine, the Philadelphia Inquirer reports (Pugh, Philadelphia Inquirer, 3/16). For the study, funded by the Robert Wood Johnson Foundation, researchers at RAND examined data collected through telephone interviews and medical records from a nationally representative sample of 6,712 adults in 12 communities between 1998 and 2000. Researchers used 439 accepted standards to evaluate the quality of care that participants received for 30 common chronic and acute medical conditions and for disease prevention. According to the study, participants overall received appropriate medical care 54.9% of the time. Black participants received appropriate medical care 57.6% of the time, compared with 57.5% for Latino participants and 54.1% for white participants, the study finds (Stein, Washington Post, 3/16). The study also finds that female participants received appropriate medical care 57% of the time, compared with 52% for male participants (Philadelphia Inquirer, 3/16). Participants with annual incomes of more than $50,000 received appropriate medical care 57% of the time, and those with annual incomes of less than $15,000 received appropriate medical care 53% of the time, according to the study. In addition, the study finds that participants without health insurance received appropriate medical care 54% of the time, compared with 55% for those enrolled in managed care plans (Donn, AP/Barre-Montpelier Times Argus, 3/16). According to the study, younger participants and those with higher incomes were more likely to receive diagnostic tests but less likely to receive follow-up care.
Study Author Comments
According to the authors of the study, the U.S. health care system should provide appropriate medical care 80% to 90% of the time. Steven Asch, lead author of the study and senior natural scientist at RAND Health, said, "Not only is no place safe -- no one is safe from poor quality. No matter what group we looked at, whether they were black, white, rich or poor, uninsured, insured, educated, uneducated -- all of them were receiving mediocre care" (Philadelphia Inquirer, 3/16). He added, "So many previous studies have shown disparities. In that way, it is surprising. We looked in as many ways as we could to try to determine if there was problem with our analysis. I'm convinced that's not the case." Asch said that, although minority and low-income patients have more problems with health care access and are less healthy than white and higher-income patients, the study indicates "those differences appear not to be due to the bread-and-butter medical care they receive" (Washington Post, 3/16). In addition, Asch said that increased use of health care information technology could help improve the quality of care provided by the U.S. health care system (Philadelphia Inquirer, 3/16). Asch said, "This study should be a challenge to all of us to fix our broken system. Providers can help build unified systems of care. Patients can advocate for better care. And payers can use their purchasing power to institute reforms in information technology" (Ackerman, Houston Chronicle, 3/16).
Reaction
According to some health care experts, the study supports "the idea that efforts to improve care should focus on increasing quality for everyone, not equalizing care between races," the Washington Post reports. Sally Satel of the American Enterprise Institute said, "The obsession with racial disparities is a distraction from what we really need to do, which is improve health care for everyone." Amitabh Chandra of the Kennedy School of Government at Harvard University said, "Just because you see disparities doesn't mean that everyone should be getting more care. Maybe they should be getting less care. There's a big question about overuse. It may not be what's being done but whether you are being treated by a high-quality physician." However, David Williams of the University of Michigan said that the study might have excluded low-income U.S. residents who do not have telephones or never visit physicians. He said, "I wouldn't use this to generalize either by economic or race and ethnicity. This data is not consistent with lots of data we have on a national basis" (Washington Post, 3/16). Some health care experts attributed the results of the study to an "overburdened, fragmented system that fails to keep close track of patients with an increasing number of multiple conditions," the AP/Times Argus reports (AP/Barre-Montpelier Times Argus, 3/16).
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