Access Matters: Tracking Regional Differences in Quality Health Care

In an article in The New England Journal of Medicine, David C. Radley and Cathy Schoen examine the relationship between the quality of care and access to care in different geographical regions. They find that access varied markedly from state to state and that as access decreased, so did the quality of care.

The authors analyzed data from Scorecard, a system that tracks 43 health system performance measures grouped into four categories: access, prevention and treatment, potentially avoidable hospital use and cost, and healthy lives. They examined these measures across 306 hospital referral regions (HRRs), designated as, “regional health care markets defined with the use of patient-flow data [from 2008 to 2010] for the Dartmouth Atlas of Health Care.”

Across HRRs, variation in residents’ ability to obtain care was substantial. The proportion of adults 18 to 64 years old without health insurance was five percent in Massachusetts but greater than 50 percent in two areas in Texas. The proportion of adults who chose to forego care, due to cost, ranged from 5 to 33 percent across the U.S. Variation in preventive care was also large: among adults over the age of 50, as few as 26 percent and as many as 59 percent received routine preventive care, such as screenings for cancer and an annual influenza vaccine.

As access to care varied across HRRs, so did the quality of care. The researchers found HRRs with lower numbers of residents with access to care also had lower quality of care on several indicators. In the same vein, increased access to care was associated with, “fewer Medicare beneficiaries who received prescriptions for unsafe medicines…or who experienced a potentially avoidable visit to the emergency room.”

Despite their findings, the authors remain optimistic in light of the 2010 Patient Protection and Affordable Care Act (ACA). The ACA is one step toward remedying the variation in access to care and the poor quality generally present in HRRs wherein adults display little access to care.

They state, “the ACA provides new resources and investment in primary care, as well as opportunities for physicians to work together to make delivery systems accountable for care experiences, outcomes, and costs through timely preventive care and the effective management and coordination of care of patients with complex conditions.”

However, they temper their optimism by noting that collaboration among several groups—including local clinicians, policy makers, and insurance companies—will be key to the construction of effective health care systems.

Feature photo: cc/Alex E. Proimos