Most Get Mediocre Health Care

The above headline came from a March 16, 2006, Associated Press story by Jeff Donn that appeared in many newspapers and online outlets. The article was based on a study published in the March 16th New England Journal of Medicine (NEJM) and starts out by noting that, "Americans -- rich, poor, black, white -- get roughly equal treatment, but it's woefully mediocre for all".

In this study, researchers examined medical records and conducted phone interviews with 6,712 randomly picked patients who visited a medical office within a two-year period in 12 metropolitan areas from Boston to Miami to Seattle. The survey questioned whether people got what researchers considered to be the highest standard of medical treatment for 439 items measured for both common chronic and acute conditions and disease prevention. They investigated to see whether people got the right tests, drugs and medical treatments.

The results of the study showed that overall patients received only 55 percent of recommended steps for what the researchers determined was top-quality medical care. Interesting and contrary to what researchers expected to find, the study results showed that Blacks and Hispanics as a group each got 58 percent of the best care, compared to 54 percent for whites. Finances did play a role in that households with an income over $50,000 got 57 percent, 4 points more than people from households of less than $15,000. Additionally, patients without insurance got 54 percent of recommended steps, just one point less than those with managed care. The study also showed that women came out just slightly ahead of men in receiving optimum care.

Dr. Donald Berwick, who runs the nonprofit Institute for Healthcare Improvement in Cambridge, Massachusetts, commented, "This study shows that health care has equal-opportunity defects." Dr. Steven Asch, at the Rand Health research institute, in Santa Monica, California, and study chief author agreed, "It doesn't matter who you are. It doesn't matter whether you're rich or poor, white or black, insured or uninsured. We all get equally mediocre care".

In the discussion the NEJM study speaks to the problems in the way medical care is rendered, "These results underscore the profound and systemic nature of the quality-of-care problem." The authors of the NEJM study concluded by stating, "In this study, we have now shown that individual characteristics that often have a protective effect do not shield most people from deficits in the quality of care. As the Institute of Medicine has concluded, problems with the quality of care are indeed widespread and systemic and require a system-wide approach."