Health Care Quality Crisis in America

I think "good" quality care means getting the right kind of treatment at the right time: no more or no less. As one report from Robert Wood Johnson Foundation mentioned, when we analyze further, there are 3 key dimensions that can conceptually describe the quality crisis we are facing in health care: “underuse,” “overuse” and “misuse” of care.

Neither of them will bring about the "good quality of care".

• “Underuse” of care means having less than what is recommended. Eg. Not getting enough medication for proper treatment of a disease.

• “Overuse” of care means prescribing advanced antibiotics for simple infections. In one study published by Dartmouth Atlas of Health Care in 2006, it was found that Medicare reimburses about $50,000 more for health care services during the lifetime of a 65-year-old living in Miami than it does for a 65-year-old in Minneapolis, simply because Miami has more acute care resources—including hospital beds and specialists—relative to the size of its Medicare population. The health care outcomes of those patients in Miami are not better.

• “Misuse” of care can be either failure to properly carry out appropriate treatment protocols or the use of inappropriate ones. Eg. Medical errors like adverse reactions to drugs, surgical injuries and other serious harms to patients.

I think it is difficult to improve quality because, the health care costs are already very high and different stakeholders—patients, health care professionals, health insurance companies etc—perceive these problems with quality in different ways. More importantly, quality is associated with other interrelated elements like cost and access. We can't just focus on one and ignore the others when addressing the quality crisis in health care.

According to former Secretary of Health and Human Service nominee, Tom Daschle, we need to be more transparent as well when it comes to quality issues in health care. He said that we are eager to put forward things, related to quality issues in other sectors almost instantaneously; like how many people died because of the jet engine failure for example. But, we seldom see how many people die because of medical errors or negligence in frontline pages.

Why doesn’t they are in the frontline pages? It’s because we have very little transparency when it comes to quality in health care and we don’t have enough infrastructure to address it. So, unless we have the kind of health infrastructure that can reflect the problems in health care sectors better and become more transparent about medical "abuses", the goal of providing “quality health care” will still be a far-fetched dream.