May 9, 2001
RAND: US faces healthcare 'quality deficit'
NEW YORK, May 09 (Reuters Health) - The quality of care in America
is often substandard, yet policymakers have failed to act decisively
to correct the problem, according to a team from
RAND Health, a leading healthcare think tank.
RAND's Elizabeth A. McGlynn and Robert H. Brook describe the
nation's quality deficit and the barriers to improving quality
in the May/June issue of the journal Health Affairs.
Many measures suggest that the US healthcare system is not up
to snuff. A recent World Health Organization report, for example,
ranks the nation 37th in the world in overall health system
performance and 72nd on population health.
Furthermore, the Institute of Medicine's pivotal November 1999
report on quality estimated that medical errors cause as many
as 98,000 deaths a year.
Quality of care is not exclusively an American problem. Around
the globe, only half of what is recommended in medicine gets done,
according to McGlynn and Brook. Yet serious action to
improve the situation in America has yet to emerge, they said.
The authors describe several reasons for why poor quality persists
and why it is difficult to sustain public interest in the problem.
Unlike defective tires and faulty rudders, problems with processes
or healthcare outcomes cannot be blamed on a single company, like
Firestone or Boeing. "There is rarely a credible threat
that poor-quality providers will be driven out of business or
even suffer a significant loss of revenue," the RAND team
The nation also lacks basic information on how well the healthcare
system is functioning, such as a national system for identifying
defects and correcting them before someone dies, McGlynn
and Brook note.
And despite amazing technological advances, most physicians and
hospitals rely on illegibly handwritten notes to track a patient's
course of treatment and progress, they add.
Attitudes also play into the problem, with many people believing
that their own doctor is excellent and that data documenting quality
problems are inaccurate.
To change the system, "we need a 'war on poor quality' that
has the same level of public commitment as the war on cancer or
the campaign to put a man on the moon," the team concludes.
They also call for better information systems, routine monitoring
and reporting on performance and a multi-billion-dollar annual
commitment to funding quality measurement.
"We must find a way to keep quality of care at the top of
the health policy agenda," McGlynn and Brook urge. "After
providing insurance to all Americans, there is no issue of equal
SOURCE: Health Affairs 2001;20:82-90.