We would like to think that we’re getting quality care every time we see a doctor or go to the hospital for an emergency. But that may not always be the case. The United States spent $2.5 trillion on health care in 2009 - more than any other country - and yet the outcomes of our care weren’t as good as those in other countries, according to the Institute of Medicine (IOM), a branch of the National Academy of Sciences that provides nonpartisan advice on health issues.
What Should We Expect from Our Health Care?
One goal of healthcare reform is to improve the quality of carein the United States. But what does that mean? According to another report from the IOM, quality care requires a commitment from patients, providers, legislators and industry - “to continually reduce the burden of illness, injury, and disability, and to improve the health and functioning of the people of the United States…” by insisting that the health care we receive is:
- Safe: avoiding injuries to patients from the care that is intended to help them.
- Effective: providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit.
- Patient-centered: providing care that is respectful of and responsive to individual patient preferences, needs and values, and ensuring that patient values guide all clinical decisions.
- Timely: reducing waits and sometimes harmful delays for both those who receive and those who give care.
- Efficient: avoiding waste, including waste of equipment, supplies, ideas and energy.
- Equitable: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location and socioeconomic status.
How Does the Affordable Care Act Address Quality of Care?
The Affordable Care Act (ACA) addresses concerns about quality of care in both direct and indirect ways. Read on for some examples.
- Accountability from Insurance Companies - The ACA requires insurance companies to spend 80 to 85 percent of your health insurance premium dollars on health care and quality improvement or give you a rebate.
- Emphasis on Prevention - The ACA emphasizes prevention by investing in wellness. By staying well, we may be able to avoid or lessen the impact of many diseases and their accompanying costs.
- Creation of Health Homes -The ACA provides an option to state Medicaid programs to provide and coordinate care in your community as an alternative to institutional care. A health home is a designated provider or team of providers who coordinate the patient’s treatment, which includes services, transitions to and from the hospital, support services and referrals to other community services.
- Improvements in Community Health Centers -The ACA also provides for improving the quality of our care by strengthening the nation’s network of community health centers and testing new methods for delivering services, for example, coordinating care among physicians and community resources. (Visit http://innovations.cms.gov/ for more information on the Center for Medicare & Medicaid Innovation and its mission to improve quality of care and reduce rising healthcare costs.)
- Changes to How Healthcare Providers and Hospitals Do Business - By insisting on accountability and providing incentives, the intent of the ACA is to reward healthcare providers who successfully coordinate patient care, improve quality, stress prevention, and reduce the number of hospital admissions. For example, patient records are to be recorded electronically to reduce paperwork, costs and medical errors, and to make it easier to share health information with you and your other providers.
- Data Collection to Address Disparities - Collecting data on race and ethnicity can help us identify disparities and improve the quality of care for everyone in the United States.
- Attracting and Training Primary Care Physicians in Every Community - Providing more training opportunities for primary care health professionals and offering incentives for practice in underserved areas may attract more primary care physicians to serve these communities.
- Strategy Initiatives and Funding - The ACA calls for the creation of administrative bodies and funding to study and improve health care in the United States, for example:
- Funding for Comparative Effectiveness Research to determine which treatments provide the best quality of care
- Preventive and Public Health Fund to promote preventive and public health programs
- National Prevention, Health, Promotion and Public Health Council (National Prevention Council) to develops a national and public health strategy
- Center for Medicare and Medicaid Innovation to tests new healthcare payment and delivery system models, for example, Accountable Care Organizations that provide incentives for doctors to work together to better coordinate your care and value-based purchasing, a program that rewards hospitals with financial incentives to improve quality of care.
What Can You Do to Improve Your Quality of Care?
Get involved! As a consumer of medical care, just like in other areas of your life, you may have to shop around, ask questions and let providers know that you expect the best. The more you know about the product, the better off you’ll be.
Government websites and others offer tools to help you find quality care, for example:
You can also participate in improving the quality of your care by learning as much as you can about treatment options available to you and discussing them with your doctor.
Note: This website and the information contained, expressed or implied herein are made available solely for general informational purposes and are not intended to be legal, tax, health, medical or professional advice or the sole source of information about health insurance coverage or specific health plans. While every effort is made to ensure that this information is accurate and current, SCAI makes no guarantees and disclaims any expressed or implied warranty or representation about its accuracy, relevance, timeliness, completeness or appropriateness for a particular purpose.