WASHINGTON—A report released Thursday says that expanding health care access to the nation’s uninsured population without making sure they receive appropriate, cost-effective care will lead to higher costs without improving their health status.
The National Committee for Quality Assurance’s report says the U.S. health care system has reached a “performance plateau” despite steady increases in spending and a decade of improvements in the health care system. This trend was evident in care provided to individuals with private insurance, Medicare and Medicaid.
The NCQA also found that when quality measures were combined with an assessment of the amount of resources used to treat patients, there was no direct relationship between cost and quality.
“Health care doesn’t follow the pay-more-get-more rule,” NCQA Executive Vp Greg Pawlson said in a statement.
The report also said there are wide variations in health care quality based on geography, with individuals living in New England more likely to receive appropriate care than those in South Central states.
For example, health plans in New England were 16.3% more likely to treat diabetic patients according to accepted guidelines compared with health plans in South Central states. New England health plans also were 19.2% more likely to ensure that patients received all appropriate cancer screenings compared with health plans in South Central states.
According to the report, key areas of care that have not shown improvement over the past several years include:
“We spend twice as much as any other nation on health care,” yet “we get it right about half the time,” NCQA President Margaret O’Kane said during a news conference where the report was released.
Based on the findings, Ms. O’Kane called on Congress to reform payment systems that undermine efforts to improve the quality of care; expand quality measurement to the 60% of U.S. residents not currently covered by plans that report to the NCQA; invest in development and implementation of quality measures; and revitalize the nation’s primary care system.
As Congress works to shape a final health reform bill, “it is a time to be especially vigilant to ensure that quality doesn’t get left on the cutting room floor,” Ms. O’Kane said. “If we really want quality, we have to send a signal to the health care system that we’re serious.”
The NCQA’s 2009 State of Health Care Quality Report examines quality data submitted by 979 health plans across the country that collectively cover 116 million individuals, a 9% increase over 2008. Plans submit data using the NCQA’s Healthcare Effectiveness Data and Information Set, which measures how often patients receive care that conforms to evidence-based guidelines.
The complete report is available at www.ncqa.org/sohc.
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