search feedback link archive home

Parathyroid hormone may help battle osteoporosis

Doctors control spread of antibiotic-resistant bug

Healthier cattle feed benefits animals and people

Younger than 55? Alcohol risks outweigh benefits

Women have poorer body image than men

Finding disease genes may not be so difficult

Drug users need regular medical, drug abuse care

Study links child's depression with later obesity

RAND: US faces healthcare 'quality deficit'

Exercise keeps women's minds in shape

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 writes.

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 importance."

SOURCE: Health Affairs 2001;20:82-90.

Copyright © 2001 Reuters Limited. All rights reserved. Republication or redistribution of Reuters content, including by framing or similar means, is expressly prohibited without the prior written consent of Reuters. Reuters shall not be liable for any errors or delays in the content, or for any actions taken in reliance thereon. Reuters and the Reuters sphere logo are registered trademarks and trademarks of the Reuters group of companies around the world.