AHRQ: Healthcare access, quality uneven

Healthcare quality is improving, but access is still uneven and disparities exist, especially for minority and low-income groups, according to the 2010 National Healthcare Quality Report and National Healthcare Disparities Report from the Agency for Healthcare Research and Quality (AHRQ).

The reports found the following disparities in quality of care are common:

  • Blacks, American Indians and Alaska natives received worse care than whites for about 40 percent of core measures.
  • Asians received worse care than whites for about 20 percent of core measures.
  • Hispanics receive worse care than non-Hispanic whites for about 60 percent of core measures.
  • Poor people received worse care than high-income people for about 80 percent of core measures.
Measures were classified as either process measures or outcome measures. Process measures are further subdivided, when possible, into preventative care, acute treatment and chronic disease management. The core measures were the most important and they support measures in the full reports measure set.

“On average, people received the preventative services tracked in the reports two-thirds of the time,” the report found. “Moreover, wide variation was found in receipt of different types or preventive services. For instance, 20 percent of high-risk adults ages 18-64 [never] received pneumococcal vaccination, but 94 percent of children ages 19-35 months received three doses of polio vaccine.”

The report also found that people received appropriate acute care services 75 percent of the time. “Rates of receipt of acute care services ranged from a low of 8 percent among patients who needed and received treatment for an alcohol problem at a specialty facility to a high of 94 percent of hospitalized patients who indicated that communication with their doctors was good.”

Access to care is also not optimal, as on average Americans reported barriers to care one-fifth of the time, with a range from 3 percent of people noting they were unable to get or had to delay getting prescription medications to 60 percent of people remarking their usual provider did not have office hours on weekends or nights.

The study was limited because no single national healthcare database collects a comprehensive set of data elements that can produce national and state estimates for all population subgroups each year. “Rather, data come from more than three dozen databases that provide estimates for different population subgroups and data years,” the authors noted. “While most data are gathered annually, some data are not collected regularly or are old.

"Despite the data limitation, our analyses indicated that healthcare quality in American is suboptimal,” they concluded. “The gap between best possible care and that which is routinely delivered remains substantial across the nation.”

The reports are posted here. Final printed versions will be available from AHRQ's clearinghouse in March or April, according to the agency.


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