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Health Care Quality Gains Not Keeping Pace with Cost Increases

By Mary Agnes Carey, CQ HealthBeat Associate Editor

March 7, 2008 -- Improvements in health care quality are not keeping pace with the higher prices Americans have to pay for medical care, according to new data from the Agency for Healthcare Research and Quality (AHRQ).

Between 1994 and 2005—the years analyzed in two reports the agency released earlier this week—the quality of health care improved by an average 2.3 percent a year. That rate of growth was smaller than the 3.1 percent annual average improvement rate AHRQ noted last year when it measured trends between 1994 and 2004 in the areas of health care quality and health care disparities.

The quality improvement rates are lower than increases in health care spending. Over the same time period, the Centers for Medicare and Medicaid Services estimate that health care expenditures rose an average annual rate of 6.7 percent.

"Health care quality is improving only modestly, at best," AHRQ Director Carolyn M. Clancy said in a statement. "Given that health care spending is rising much faster, these findings about quality underscore the urgency to improve the value Americans are getting for their health care dollars."

AHRQ said the 2007 reports show some notable gains, such as improvements in the care of heart disease patients. When measuring what portion of heart attack patients received recommended tests, medications, or counseling to quit smoking, the reports found an average 5.6 percent annual improvement rate from 2002 to 2005.

On another front, measures of patient safety showed an annual improvement of just 1 percent, reflecting such measures as what portion of elderly patients had been given potentially harmful prescription drugs and how many patients developed post-surgery complications.

While the reports showed some reductions in disparities of care according to race, ethnicity and income, many of the largest disparities remain. Black children under 18 are 3.8 times more likely than white children to be hospitalized for asthma. New AIDS cases are 3.5 times more likely among Hispanics than whites. Among pregnant women, American Indians or Alaska natives are 2.1 times less likely to receive first trimester prenatal care.

Other highlights of the reports include:

  • More than 93 percent of heart attack patients received the recommended hospital care in 2005, up from about 77 percent in 2000/2001. The percent of heart attack patients who were counseled to quit smoking increased from about 43 percent over that two year period to about 91 percent in 2005.
  • Among people who needed treatment for illicit drug use in 2005, only 18 percent of adults between the ages of 18 and 44 actually received treatment. Only 11 percent of children between 12 and 17 got treatment. These rates have remained about the same since 2002, according to AHRQ.

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