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Report: Health Quality Improving, But to What Degree Depends on Where You Live

By Sara Lubbes Simpson

October 2, 2008 -- The quality of health care across the United States improved in 2007 despite rising health costs and a sluggish economy, reports a new study released Thursday from the National Committee for Quality Assurance (NCQA).

But the quality of health care people received varied greatly depending on where they lived. People in New England were much more likely to receive quality care than those living in the deep South, the study found. This difference in health care quality has cost about 88,000 lives a year, NCQA said.

"We pay a high price for variation in quality," said NCQA President Margaret E. O'Kane. "When it comes to quality, the current system is all over the map."

The study shows that the quality of health care improved the most for people who are enrolled in commercial health care plans instead of government programs Medicare and Medicaid.

NCQA looked at more than 800 government-run and private health plans covering more than 100 million Americans and found that private insurance companies improved the most in 2007.

The commercial plans improved in 44 of 54 measures of health care quality, including better postpartum care for mothers and newborns and better management of patients with high blood pressure.

In contrast, the study found that private health care providers within the Medicare system showed improvement in only 24 of 45 measures of quality care, and most gains were small. The providers did do a better job of making sure patients received beta-blocker treatments after heart attacks. But the number of Medicare patients being screened for breast and colon cancer went down.

For the second year in a row, the study also found that Medicaid quality has not improved. The quality of Medicaid patients' health care has instead been "relatively flat" with little improvement in the 52 measures used by the NCQA to judge quality care. One area where Medicaid services did improve, however, was that more children received childhood immunizations.

Quality of care also varied vastly from state to state, according to the study. People living in southern states such as Texas and Louisiana received care 4 percent lower in quality than the national average. Those in New England states such as Maine received care 4.7 percent better than the average. Many states do not require health care providers to report information on or measure quality of care, according to the study. Some states the reporting is "light to virtually non-existent."

To fix the problems of variation in quality of health care across health plans and regions, NCQA suggests all insurance firms—public and private—should be required to measure their quality of care and report it publicly. This move would be especially helpful in eliminating waste from the "uneven" Medicaid program, the study says.

The study suggests that the new president should set regional targets for improvements in health care and then tie federal government funding to those goals.

The entire health care system should also be overhauled to stop the emphasis on payments for treatments patients didn't necessarily need but that a doctor requested. Such practices lead to an overuse of health care services and wastes money, the study said.

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