Feature Story

Modest health care quality gains outpaced by spending

The quality of health care improved by an average 2.3 percent a year between 1994 and 2005, a rate that reflects some important advances but points to an overall slowing in quality gains, according to annual reports released by the Agency for Healthcare Research and Quality (AHRQ). The improvement rate, reported in AHRQ's 2007 National Healthcare Quality Report and National Healthcare Disparities Report, is lower than the 3.1 percent average annual improvement rate reported in the 2006 reports. Those reports measured trends between 1994 and 2004.

Quality improvement rates are lower than widely documented increases in health care spending. The Centers for Medicare & Medicaid Services estimate health care expenditures rose by a 6.7 percent average annual rate over the same period. The 2007 reports—the fifth editions since the reports' inaugural release in 2003—show some notable gains, such as improvements in the care of heart disease patients. When measuring what portion of heart attack patients received recommended tests, medications, or counseling to quit smoking, the reports found an average 5.6 percent annual improvement rate from 2002 to 2005. Measures of patient safety showed an average annual improvement of just 1 percent. That modest improvement rate reflected such measures as what portion of elderly patients had been given potentially harmful prescription drugs and how many patients developed post-surgery complications.

The reports also showed some reductions in disparities of care according to race, ethnicity, and income. For example, while Hispanics remain more likely than whites to get delayed care or no care at all for an illness, that disparity decreased between 2000 to 2001 and 2004 to 2005. In addition, while black children between 19 and 35 months old remain less likely than white children to receive all recommended vaccines, that disparity also decreased.

Overall, however, many of the largest disparities remain. Black children under 18 are 3.8 times more likely than white children to be hospitalized for asthma. New AIDS cases are 3.5 times more likely among Hispanics than whites. Among pregnant women, American Indians or Alaska natives are 2.1 times less likely to receive first trimester prenatal care.

Editor's Note: AHRQ's Quality and Disparities Reports, which are mandated by Congress, are read widely by policymakers, health care analysts, public health advocates, health insurers, journalists, and consumers. This year's National Healthcare Quality Report synthesizes more than 200 "quality measures," which range from how many pregnant women received prenatal care to what portion of nursing home residents were controlled by physical restraints. The National Healthcare Disparities Report summarizes which racial, ethnic, or income groups are benefiting from improvements in care. The 2007 reports draw on data from more than three dozen databases, most sponsored by Federal health agencies. The quality report serves as the basis for AHRQ's upcoming State Snapshots, which come out each spring and detail how health care quality trends vary from State to State.

The reports are available online at http://www.ahrq.gov/qual/qrdr07.htm or from the AHRQ Publications Clearinghouse.

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