Quality of Care
U.S. Health Care: Facts about Cost, Access, and Quality
The U.S. spends approximately 15 percent of its gross domestic product on health care, making health care the largest single sector of the U.S. economy. Despite these levels of expenditure, Americans are not healthier and do not live longer than citizens in many other nations. American adults receive just half of recommended health care services, and quality does not vary much by socioeconomic factors. Focusing on the nation as a whole, this chart book provides an overview of key health care policy issues in the areas of cost, access, and quality.
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In the United States, a large gap exists between the care people should receive and the care they do receive. Originating in the 1960s, RAND Health has conducted extensive research designed to measure, assess, and improve health care quality and to provide reliable decision support information on quality to patients, providers, and purchasers. Current projects are briefly described below.
Profiles of Current Research
Mental Health and Substance Abuse Care
Highlights of Recent Studies
Consumer-Directed Health Care
Consumer-directed health plans typically reduce the use of health services and cut costs, but they have mixed effects on quality of care.
Effects of Medicare's Prospective Payment System on the Quality of Hospital Care
The prospective payment system had no negative effect on patient outcomes and did not alter an already existing trend toward improved processes of care.
Organizing for Quality: Inside the "Black Box" of Health Care Improvement in Europe and the United States
Summarizes a book on health care quality improvement efforts, suggesting a focus on the organizational and human dimensions of change and the processes by which these dimensions are set in motion and unfold over time.
Measuring the Quality of Cancer Care
According to the National Initiative for Cancer Care Quality, a prototype cancer-care quality monitoring system, patients with breast cancer in five U.S. major metropolitan areas receive about 86 percent of recommended care, and patients with colorectal cancer receive about 78 percent of recommended care.
Three Steps for Improving the Quality of Mental Health Care in the United States
To accelerate progress in improving the quality of mental health care: (1) expand the pool of effective programs and adapt them to a broader range of settings, (2) improve the infrastructure for delivering evidence-based treatment, and (3) promote innovation in financing.
The First National Report Card on Quality of Health Care in America
Overall, adults receive about half of recommended care, and all sociodemographic groups are at risk for poor care quality.
Related Web Sites
UCLA/RAND NIMH Center for Research on Quality in Managed Care
http://www.hsrcenter.ucla.edu/research/
Improving Chronic Illness Care Evaluation (ICICE)
http://www.rand.org/health/projects/icice/
Partners in Care
Assessing Care of Vulnerable Elders (ACOVE)
Consumer Assessment of Health Plans Study (CAHPS)
Working with Congress
RAND's Washington Office of Congressional Relations (OCR) furthers RAND's mission to provide objective analysis and effective solutions by disseminating research results to Congress and federal agencies. The OCR publishes a monthly electronic newsletter featuring current work on health policy. Contact: Shirley Ruhe (Shirley_Ruhe@rand.org) or Kristy Anderson (kristy@rand.org).
The RAND Health Congressional Newsletter
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