Health Care Quality Improves a Bit; Disparities in Care Continue

The overall quality of health care in the United States continues to improve, but health care disparities persist among racial, ethnic and socioeconomic groups. These findings appear in the 2006 National Healthcare Quality Report and the 2006 National Healthcare Disparities Report, both recently issued by the Agency for Healthcare Research and Quality, or AHRQ.

These annual AHRQ reports to Congress provide a snapshot of the country's health care according to the latest available data; some of the information included in each year's reports is drawn from surveys conducted in earlier years.

In assessing 40 core measures of quality, AHRQ found a 3.1 percent overall improvement rate compared with the quality level described in its 2005 quality report. The combined rates of delivery of appropriate vaccinations to children, adolescents and the elderly improved by almost 6 percent, but the combined improvement rates for other preventive measures -- such as health screenings, advice (e.g., on quitting smoking, exercising or healthy eating), and prenatal care -- totaled less than 2 percent.

"It's encouraging to learn that overall quality continues to improve," said AHRQ Director Carolyn Clancy, M.D., in a Jan. 11 news release on the two reports. "At the same time, the message is clear: Much more can be done to prevent illness from occurring or progressing."

The 2006 quality report points to areas for improvement by presenting data such as:

AHRQ's disparities report compares health care measures across various populations. The report says, for example, that blacks received poorer-quality care than whites for 73 percent of the 22 core measures used to measure disparities, including vaccinations, hospital treatment of pneumonia, and communication problems between adult patients and their health care professionals. However, blacks received better-quality care for 9 percent of the core measures; for example, blacks had lower rates of physical restraints in nursing homes than whites.

Hispanics received poorer-quality care than non-Hispanic whites for 77 percent of the core measures for disparities, including administration of pneumococcal vaccine for the elderly and hospitalization of children for gastroenteritis, according to the disparities report. But Hispanics had higher-quality care for 18 percent of the core measures, having higher rates of adequate hemodialysis and lower rates of late-stage colorectal cancers.

Poor people -- that is, those with family incomes less than the federal poverty level -- fared worse than high-income people -- those with family incomes at least four times the poverty level -- according to the disparities report. For example, among adults 40 or older with diabetes, 54 percent of those with high incomes did not receive three recommended services for diabetes in 2000, and the percentage dropped to 41 percent in 2003. By contrast, in 2000, 68 percent of low-income people did not receive the services, and the percentage dropped only to 63 percent in 2003.

The disparities report highlights people's need for health insurance. "Among adults, the negative effects of being uninsured are typically larger than the effects of race, ethnicity, income and education," says the report. It notes that 49 percent of privately insured people received recommended colorectal cancer screening, but only 22 percent of uninsured people had such screening.

In related news, the Kaiser Family Foundation issued its reference on health disparities, Key Facts: Race, Ethnicity and Medical Care, 2007 Update, in January. Key Facts reviews demographic characteristics of the U.S. population; examines health status by patients' race, ethnicity and income; describes patterns of health insurance coverage; analyzes data concerning preventive and primary care; and gives information on the "disproportionate effect" that conditions such as asthma, diabetes and HIV/AIDS have on racial and ethnic minority populations.