MARCH 16, 2006 -- Americans received about 55 percent of the recommended medical care they need, regardless of their race, sex, income, or where they live, according to a new RAND Corporation study.
The findings, published in Thursday's edition of the New England Journal of Medicine,, also found that blacks and Hispanics fared better than whites on routine medical care and that women were more likely to receive preventive medical care.
The study "tells us that the U.S. health care system is unreliable and cannot guarantee that patients—rich or poor, white or black, insured or uninsured—will receive the right care at the right time," said Elizabeth McGlynn, associate director of RAND Health and the study's senior author. "We need to fundamentally redesign the health system to ensure that no matter who you are or where you go for care you will get what you need."
The study, billed as the largest and most comprehensive examination conducted of health care quality in the United States, found that while some disparities in care do exist they are small relative to the gap between the medical care individuals need and what they are actually receiving.
The study's findings add new information to the ongoing debate over race and disparities in health care treatment. A 2002 Institute of Medicine study, for example, recommended increasing awareness about racial disparities, based on findings that racial and ethnic minorities experience a lower quality of care and are less likely to receive routine medical procedures—even when insurance status, income, age, and the severity of medical conditions are comparable.
The RAND study was funded by the Robert Wood Johnson Foundation. Nearly 7,000 adults in 12 nationally representative metropolitan areas participated in the study, which evaluated performance on 439 indicators of quality for 30 acute and chronic conditions such as urinary tract infections, diabetes, asthma, high blood pressure, and heart disease, along with preventative care. Individuals participating in the study had seen a provider at least once during the previous two years.
Insurance status had no real effect on the quality of care provided, the authors noted. When all patients have equal access to medical care, disparities in care according to race or ethnic group are often reduced or even reversed, they said.
Findings of the report include:
- Women received a higher proportion of recommended care than men and were more likely than men to receive preventive services. Women, however, were less likely than men to receive needed acute medical care.
- For routine medical care, overall quality scores for blacks were 3.5 percentage points higher than for whites. Overall quality scores for Hispanics were 3.4 percentage points higher than for whites.
- Blacks had higher scores than whites for chronic care—61 percent vs. 55 percent.