Poorer health outcomes can be attributed in part to the failure of our health care system to ensure that Americans receive the right care. A RAND Corporation study documented that recommended care is delivered only 55 percent of the time.
(5) The rate varies across health conditions, ranging from 76 percent for treatment of breast cancer to 23 percent for hip fractures. But even the best rate is not good enough: it is not acceptable that one-fourth of women with breast cancer fail to get a chance at a healthy outcome because the care rendered does not meet professional standards. A study cofunded by The Commonwealth Fund at Mount Sinai Medical School found that, among the 14 percent of women diagnosed with breast cancer who received less-than-optimal treatment for their cancer at four northern Manhattan hospitals, nearly one-third of the failures could be traced to the lack of an effective mechanism for following up with the women and ensuring they receive needed care.
This uneven application of the best that modern medicine has to offer is troubling, but it is particularly troubling that those without health insurance are much less likely to receive high-quality care. The Institute of Medicine estimates that 18,000 uninsured Americans between the ages of 25 and 64 die each year simply because they are uninsured and therefore get lower-quality care or fail to receive preventive care that might have detected conditions at an earlier stage.
(6)Even for people with insurance coverage, quality of care is uneven. One analysis of Medicare medical records found wide variations across states on 22 quality indicators.
(7) More must be done to understand why states like Maine and Minnesota consistently rank in the top tier while states like California, Florida, and Texas are at the bottom. Differences exist even in the best states. A study by the Maine Quality Forum found that the percentage of hospitalizations that could have been prevented with better primary care varies twofold, from 15 percent of all hospital patients in some regions of the state to more than 30 percent in others.
(8)
