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BMJ 2002;324:1476 ( 22 June )
 

News roundup

Report highlights patchy quality of US health care

Lynn Eaton London

The quality of health care in the United States—which arguably provides some of the best health care in the world—is not necessarily as good as it seems, according to a report from an adviser to the Nuffield Trust.

Professor Sheila Leatherman’s report, edited by Douglas McCarthy and published by the New York based Commonwealth Fund, highlights the lack of preventive care, medical mistakes, substandard care for chronic conditions, and disparities in care.

It also indicates that the widespread misuse of antibiotics for conditions such as sore throat has led to the emergence of new strains of bacteria that are resistant to treatment with antibiotics. Throughout most of the 1990s the annual percentages of patients visiting their doctor with a sore throat who were given antibiotics ranged from 66% to 82%. Although the percentage in 1999 fell to 57%, after new guidelines had been issued, this is still well above the range of 11-33% that would be expected if clinical guidelines were followed.

And with one in seven Americans not insured for health care, the research shows that adults who are not insured were up to three times more likely to report not seeing a doctor when they needed to than those who had insurance.

To improve the quality of health care, Professor Leatherman suggest that an improvement is needed in insurance cover for those who are not insured. Of particular concern are those who are in poor health or have chronic conditions such as diabetes that need regular medical care and follow up.

Among the other shortcomings of the US healthcare system, the report also highlights the fact that:

· 27% of young children (aged 19-35 months) were not fully up to date on all recommended doses of five key vaccines in 2000

· During 1987-95, rates of prescribing mistakes with the potential for adverse outcomes

more than tripled in proportion to hospital admissions

· 14-24% of elderly patients were prescribed drugs that could potentially cause harm or have questionable effectiveness

· 59% of patients from ethnic minority groups and 38% of white patients had inadequate pain management

· Black patients with coronary artery disease were less likely than white patients to receive procedures that restore blood flow to the heart.

The report also shows that only 53% of the American public think the quality of health care in the United States is good or excellent, and 57% of US doctors say that their ability to provide health care has got worse in the last five years.

"Quality problems can’t be cured by simply spending more money," said Professor Leatherman. "The US already spends more on health care per capita and as a proportion of gross domestic product than any other nation. New approaches, based on better diagnosis of the problems of quality and implementation of effective corrective strategies, will be needed," she said.

Professor Leatherman, who holds academic posts at the University of North Carolina School of Public Health and the Judge Institute at the University of Cambridge, England, has also been commissioned by the Nuffield Trust to undertake a midterm appraisal of the UK government’s 10 year quality agenda for the NHS.

"The British public is expecting significant quality gain from the chancellor’s huge, and welcome, investment in the NHS," said the Nuffield Trust's secretary, John Wyn Owen.

He has circulated Professor Leatherman's report for the Commonwealth Fund to UK ministers, with a warning that it illustrated that large expenditure on health services does not assure high quality.

Quality of Health Care in the United States: A Chartbook by Sheila Leatherman and Douglas McCarthy is available at www.cmwf.org
 
 

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Ned Hoke

bmj.com, 20 Jun 2002 [Full text]

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