According to American Medical News, the U.S. health system is demonstrating better performance on most measures of health care quality, but it’s failing to improve access to care or cut racial and ethnic health disparities, according to two reports released in February by the Agency for Healthcare Research and Quality. “Quality of care continues to improve, but at a slow rate,” said Ernest Moy, MD, leader of the team at AHRQ that produced the reports. ”In contrast to that, focusing on issues of access to care, not much has changed. Focusing on disparities in care, not much changed…Those are bigger problem areas than overall quality of care.” Measures related to hospital quality are showing the most improvement. For example, in 2005, just 42% of patients with heart attacks received angioplasties within the recommended 90 minutes of arriving at the hospital. That figure improved to 81% by 2008.
While the quality improvement indicators are encouraging, the disappointing access and disparities numbers are not very surprising.
The US health care system is still largely focused on acute hospital based care. It says we are doing better at what we are doing. But an unbalanced focus on acute disease treatment is also a major part of the problem. The major causes of sickness, lost productivity at work and missed days at school are not acute illnesses but chronic diseases. In fact, according to Ban Ki-moon, Secretary General of the United Nations, chronic disease causes 6 out of every 10 deaths worldwide. It is what happens outside the hospital that is the largest determinant of what needs to happen when someone is a patient inside a hospital.
If we do little to nothing about this problem, we fail – as a nation and a world – to achieve the health goals we have set and believe possible. This is why global business leaders meeting at the World Economic Forum in Davos, Switzerland recently made addressing the problem of chronic diseases a priority. In fact, Paul E. Jacobs, Chairman and Chief Executive Officer, suggests that one exciting development is in the field of telehealth and mobile medicine, where high mobile telephone penetration, particularly in the developing world, can be used for prevention and health promotion. Indeed, this is already happening for treatment of diabetes and detecting cardiac arrhythmia – it is not a pipe dream.
Those in America who would continue to resist reforming our health care system do so to their own peril and that of their children and grandchildren. Rather, the US should lead the world in global health and health care innovation to address challenging chronic disease concerns and disparities. If we can put a man on the moon and eradicate small pox from the face of the earth, there is no doubt we can overcome chronic disease disparities, should we decide…we simply must.
Chris Gibbons, MD, MPH, is the associate director of the Johns Hopkins Urban Health Institute, the director of the Johns Hopkins Center for Community Health, and holds faculty appointments at the Johns Hopkins Schools of Medicine and Public Health.
*This blog post was originally published at CFAH PPF Blog*