SPM member Nancy B. Finn shares some recent research findings that confirm what many of us suspected about the value patients get out of health care in the U.S.

When we go to the supermarket or the store to make a purchase, most of us are concerned about getting what we paid for — a quality product for an equitable price. When it comes to our health care, though, we are increasingly frustrated with a system where we too often get a low quality product at a very high cost.

A recent study, conducted by the Robert Wood Johnson Foundation (RWJF), National Public Radio (NPR) and the Harvard School of Public Health, concluded that both cost and quality of health care have worsened over the past five years and continue to be a serious problem. The study, conducted by telephone, was based on interviews with 1,508 adults who were age 18 and older and were diagnosed with illness. About half of these individuals reported that they were highly satisfied with the quality of medical care they have received but the other half have more divided views.

These individuals reported that in their opinion, the top reasons for the continued rise in the cost of their health care included: excessive charges by the payers and doctors; people not taking proper care of themselves; the obstacles that prevent patients from price comparisons; inequities in charges from different hospitals; government regulation; and the high costs of drugs, set by the drug companies.

Among the quality issues that they experience are: insurance plan restrictions; lack of available services; physicians who do not properly communicate; patients’ inability to get medical care when they need it; the number of malpractice lawsuits; people not getting the right diagnosis or treatment; fraud and abuse in the system; and care that is not well coordinated among a health care team.

One quarter of the individuals who were polled said that their treatment was poorly managed. One in eight believe they were given the wrong diagnosis, treatment, or test; one in six believe they did not get the tests they thought they needed; and 15% said they were tested or treated for something they believed to be unnecessary.

Communication or the lack of it is also a problem. One quarter of the individuals who were interviewed reported that a doctor, nurse or other health professional did not provide all the needed information about their treatment or prescriptions, and one quarter said they had to see multiple medical professionals and no single doctor understood or kept track of all the different aspects of their medical issues and treatments. Thirty percent said that their doctor or nurse did not spend enough time with them and 14% said they could not get an appointment or a referral to see a specialist they thought they needed.

We know that there are way too many medical errors happening in every facet of health care. We also know that most Americans who have health insurance are underinsured when it comes to a serious illness. More than 52% of the participants in this study indicated that they could not afford the care they needed and a quarter of these individuals said that their insurance plans would not pay for the care needed to resolve their health issue. Then there are the individuals who have no insurance at all. For them, no matter how good the product, it is unattainable.

It is obvious that there is a direct correlation between high cost and low quality of care, The fact that people are either getting too many tests or cannot get the tests that they need is concerning and elevates the cost of care for everyone over the longer term.
It was in 2001 that the Institute of Medicine issued its famous report, Crossing the Quality Chasm, that recommended that clinicians and patients work together to redesign health care processes to improve quality and bring about the changes that would result in substantial improvements and reductions in medical error. Their much talked about recommendations are still on the drawing boards over a decade later, with only minimal progress achieved.

The technology to help resolve some of the issues listed as reasons for high cost and low quality is available. There are also new approaches where patients and clinicians are working together to reduce costs and improve quality through structural redesign of healthcare delivery systems. For example, the Pioneer Accountable Care Organizations (ACOs) include teams of healthcare professionals, payers and institutions who are working together to implement comprehensive payment reform to control the cost of healthcare and institute better value for each health care dollar spent. The Pioneer ACO Model is an initiative of the Centers for Medicare & Medicaid Services that is designed to support organizations in providing more coordinated care to patients at a lower cost to Medicare.

Patient-centered medical homes are also being established around the country; here patients and doctors work together collaboratively to coordinate all of a patient’s care in one place and ensure that doctors spend more time with their patients and oversee that they are getting the treatments and tests that they need and have open channels of communication to resolve their issues.

Nevertheless, as the RWJF/NPR/Harvard study indicates, we have a long way to go before most consumers of health care can agree that the product that we are paying for is worth the cost.