Some safety lessons from US health care

The United States health system often cops a bad press, but it has some lessons for us when it comes to reporting on quality, says our correspondent in Washington, Dr Lesley Russell.

She writes:

“Last week the 2009 annual report from the National Committee for Quality Assurance  (NCQA) was released.

The NCQA is a private, not-for-profit organization that was founded in 1990. The State of Health Care Quality report monitors and reports annually on performance trends over time, tracks variations in patterns of care, and provides recommendations for future quality improvement.

This report highlights how valuable an independent analysis of quality measures for private health insurance plans and the two government-funded plans, Medicare and Medicaid, is for everyone involved – policy makers, budget managers, health care services and professionals and patients.  The analysis is based on data that the health plans report voluntarily.

This year the results are disappointing, as they show that for the third year in a row, the quality of US health care has not improved across many key measures of clinical quality.

There are probably multiple reasons for the flat results of 2009, but a key factor is the lagging US economy which has led purchasers to focus more on cost than on quality.  Insurance plans have naturally followed suit and paid more attention to negotiating discounts and less to improving performance. And the most effective tool — tying payments to performance — is not being well utilised enough, especially by the Medicare program.

A related issue is that a many Americans lose their jobs, there is greater demand on Medicaid programs at a time when stets budgets are under maximum pressure.

But the report also shows that quality care is not necessarily expensive care, which does mean that in difficult financial times, improvements in quality should still be possible

Failure to jump-start quality improvement carries a significant price. This report estimates that improvements made in years past have saved between 165,000 and 272,000 lives, and there is much more progress possible. If all health plans performed at the same level as the top 10 percent of plans (the 90th percentile), between 49,400 and 115,300 deaths could be prevented each year, along with billions saved in health care spending.

The NCQA goes further with the data which is reported to them  – they rank the plans and publish the results every year in USA Today and on their website.

This transparency is not without its downside, and the private health insurance funds, under pressure from promised health care reforms, have been doing their best to airbrush their failing results.

As the NCQA President states in the preface, “This report provides ample evidence of the need for reform. ……These warning lights cannot be ignored.”

Will we ever get to such openness in Australia?  And would we feel that health care reform was a little more urgent if we had some longitudinal data to highlight where quality could be improved, and lives and dollars saved?”

Lesley Russell is the Menzies Foundation Fellow at the Menzies Centre for Health Policy at the University of Sydney and the Australian National University, and a Research Associate at the US Studies Centre, University of Sydney. She is currently a Visiting Fellow at the Center for American Progress in Washington DC.