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Are You Getting What You Paid For and Is It Worth the Money?

When we go to the supermarket or the store to make a purchase, most of us are quite concerned that we get what we paid for  –  a quality product for an equitable price. When it comes to our health care, we are increasingly frustrated with a system where we too often get  a low quality product at a very high cost.


A recent study, conducted by the Robert Wood Johnson Foundation (RWJF). National Public Radio and the Harvard School of Public Health, concluded that both cost and quality of health care have worsened over the past five years.The study, conducted by telephone, was based on interviews with 1,508 adults who were age 18 and older  and were  diagnosed with illness.  About half of these individuals reported that they were highly satisfied with the quality of medical care they have received but the other half have more divided views.


These individuals reported that in their opinion, the top reasons for the continued rise in the cost of their  health care included: excessive charges by the payers and doctors, people not taking proper care of themselves, the obstacles that prevent patients from price comparisons; inequities in charges from different hospitals; government regulation; and the high costs of drugs, set by the drug companies.


Among the quality issues that they experience are: insurance plan restrictions; lack of available services; physicians who do not properly communicate; patients’ inability to get medical care when they need it; the number of malpractice lawsuits; people not getting the right diagnosis or treatment; fruad and abuse in the system; and care that is not well  coordinated among a health care team.


One quarter of the individuals who were polled said that their treatment was poorly managed. One in eight believe they were given the wrong diagnosis, treatment, or test; one in six believe they did not get the tests they thought they needed;15% said they were tested or treated for something they believed to be unnecessary.


Communication or the lack of it is also a problem. A quarter of the individuals who were interviewed reported that a doctor, nurse or other health professional did not provide all the needed information about their treatment or prescriptions and 25% said they had to see multiple medical professionals and no one doctor understood or kept track of all the different aspects of their medical issues and treatmments.  Three in ten said that their doctor or nurse did not spend enought time with them and 14% said they could not get an appointment or a referral to see a specialist they thought they needed.


We know that there are way too many medical errors happening in every facet of health care. We also know that most Americans who have health insurance are underinsured when it comes to a serious illness. More than 52% of the participants in this study  indicated that they could not afford the care they needed and a quarter of these individuals said that their insurance plans would not pay for the care needed to resolve their health issue. Then there are the individuals who have no insurance at all. For them, no matter how good the product, it is unattainable.


It is obvious that there is a direct correlation between high cost and low quality of care. The fact that people are either getting too many tests or cannot get the tests that they need is concerning and  elevates the cost of care for everyone over the longer term. When people are underinsured and put off treatment, or do not take their medication because they cannot afford the cost of the drugs, incremental, serious problems eventually surface. Then there are the uninsured sick  who ultimately land in the ER, which is costly for everyone.


It was in 2001 that the Institute of Medicine issued its famous report, Crossing the Quality Chasm that recommended that clinicians and patients work together to redesign health care processes to improve quality and bring about the changes that would result in substantial improvements and reductions in medical error. Their  much talked about recommendations are still on the drawing boards over a decade later, with only minimal progress achieved.


(Institute of Medicine, Crossing the Quality Chasm, National Academy Press, Washington D.C., 2001)


We have the technology to help resolve many of these issues.  There are also new approaches  where patients and clinicians are working together to reduce costs and improve quality through structural redesign of healthcare delivery systems.  For example, the new Pioneer Accountable Care Organizations  include  teams of  healthcare professionals, payers and institutions who are working together to implement comprehensive payment reform to control the cost of healthcare and institute better value for each health care dollar spent. There are also patient centered medical homes spreading throughout the country, where  patients and doctors work together  to coordinate  all of a patient’s care in one place and insure that doctors spend more time with their patients to oversee that they are getting the treatments and tests  they need to resolve their issues.


These efforts are good and they will pay off. However, as this study proves, we have a long way to go before most consumers of health care can agree that the product that we are paying for is worth the cost.