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Today's health care system harms too frequently and routinely fails to deliver its potential benefits. Quality problems are rampant and costs continue to escalate.

Medical science and technology have made huge advances, and the vast majority of America's health care professionals are dedicated to providing the best care possible with the available resources. However, the health care system continues to struggle with the task of providing the right care to the right patient at the right time. Currently, the average American has approximately a 50 percent chance of receiving appropriate evidence-based care for preventive, acute, and chronic care services.¹ The current system frequently falls short in its ability to translate knowledge into practice; an average of about 17 years is required for new knowledge generated by randomized controlled clinical trials to be incorporated into practices, and even then application is highly uneven.² This is even more surprising when coupled with the fact that more than $1 trillion is spent on medical care each year in the United States.

There is abundant evidence that serious and extensive quality problems exist throughout the U.S. health care system, resulting in harm to many Americans. As a result, of overuse, underuse, and misuse of health care services our society pays a substantial price. Indeed, approximately 30 percent of America's direct health care expenditures are wasted due to due to poor quality of care.³

Overuse: Providing health services for which the potential risks outweigh the potential benefits. Some examples include:

• Between 16 and 30 percent of the 600,000 hysterectomies performed each year are believed to be unnecessary. With complication rates of 25 to 50 percent, this means that between 24,000 and 90,000 women unnecessarily suffer complications such as severe bleeding, bowel or bladder injury, infection, blood clots, depression, and heart attack. An estimated 500 women die each year from the procedure; if 16 to 30 percent of these procedures were unnecessary, that translates into 80 to 150 avoidable deaths annually. ⁴
• Of the 110 million office-based prescriptions written annually for antibiotics and antimicrobials, 40 percent – or 44 million – are unnecessary; at a cost of over $600 million each year.⁵ For example, prescribing antibiotics for a common cold and other viral respiratory tract infections for which they are ineffective (51 percent of patients diagnosed with a cold were treated with antibiotics.)⁶
  

Underuse: Providing health care services for which the potential benefits outweigh the potential risks. There is ample evidence that many people are not receiving diagnostic and therapeutic services, medications, and procedures that have been proven to be effective (even with comprehensive insurance coverage). Millions of people with treatable conditions are not be being diagnosed (and therefore not treated), some examples include:

• Only 55 percent of female Medicare beneficiaries between the age of 52 and 69 had a mammography.⁷
• Among eligible heart attack victims, only 65 percent received early administration of beta-blockers, while only 72 percent received them at discharge from the hospital. Evidence suggests that administration of these drugs to eligible patient saves lives AND reduces costs by preventing repeat heart attacks and other acute episodes.⁸
  

Misuse: Appropriate care is provided, but in a way that does or could lead to avoidable complications. Medication errors appear to be the biggest category of misuse (16 percent of consumers report that they or a family member were the victim of a medication error, with over 20 percent resulting in a serious problem.)⁹

• As many as 44,000 to 98,000 people die in hospitals each year as the result of medical errors. Even using the lower estimate, this would make medical errors the eighth leading cause of death in this country -- higher than motor vehicle accidents (43,458), breast cancer (42,297), or AIDS (16,516). This means every year at every community hospital in the country between nine and 22 patients unnecessarily die. Medical errors cost the Nation approximately $37.6 billion each year; about $17 billion of those costs are associated with preventable errors.
• An estimated 2 million individuals suffer from hospital-acquired infections each year, leading to nearly 90,000 deaths. Between 25 to 75 percent of these infections could have been prevented.¹⁰ Based on a direct cost of $12,500 per infection, the financial toll from preventable infection runs between $6.2 and $18.6 billion each year (excluding indirect costs). ¹¹
  

More and more employers and health plans are turning to consumer driven health care concepts to more actively engage Americans in health care decisions. However, consumers are ill-equipped because of the lack of information on the relative quality, effectiveness and affordability of care givers and treatment options.

Our Solution

Recognizing that measurement and public reporting of performance are powerful mechanisms to drive quality and efficiency improvement throughout the health care system, purchasers and consumer have embraced a vision of a transparent health care market, one in which decision making is supported by comparative information. This vision of a comprehensive "dashboard" of publicly disclosed performance information should apply to all levels of the health care system – hospitals, physicians, physician groups/integrated delivery systems, and treatments. Measures should address all six improvement aims cited in the Institute of Medicine's Crossing the Quality Chasm (safe, timely, effective, equitable, efficient, and patient centered.) Driving improvements to the health care system will be achieved by (1) consumers using this valid performance information to choose providers and treatments, (2) purchasers building performance expectations into their contracts and benefit designs, and (3) providers acting on their desire to improve, supported with better information.

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