“It’s almost a flip of a coin” as to whether you receive quality health care said Dr. Steven Asch in summarizing the results of the RAND study on levels of health care quality in the New England Journal of Medicine. His team found that regardless of your race and ethnicity, gender, income or insurance status, only 55% received recommended levels of care for such things as prenatal or general preventive health services; treatment for heart disease or colorectal or breast cancers; or management of asthma, diabetes, high blood pressure or high blood cholesterol levels. In contrast to studies where receiving complex medical procedures or having access to health care services often show disparities among different gender and SES groups, these findings were from people who had access to care during a two-year period. The investigators used 439 different quality indicators that are widely known and accepted among health care providers, so as my high school motto goes: ‘ignorance is no excuse.’
According to our study, a 50-year-old white female college graduate with private health insurance and a household income above $50,000 would receive 56.7 percent of recommended care. In comparison, a 50-year-old uninsured black man with less than a high-school education and an income under $15,000 would receive 51.4 percent of recommended care (P = 0.02). Although the difference between these two hypothetical persons is significant, the gap between the care each of them receives and the standards of good practice is substantially larger than this difference and is probably much more clinically important.
Most of the focus of the study’s conclusions and a conference call
held Wednesday morning focused on the need for ‘systemic' reforms in health
care (electronic patient records and reimbursement policies being two of them). The question I raised was what is a patient suppose to do now to
improve their chances of getting higher quality care? [Social marketers can be
like that - it's that behavior thing I guess.] My initial reaction: develop quality cues patients should be using with their health care providers to better focus the clinical encounter - and maybe spend less time talking about a drug they saw advertised on television - or saying nothing at all.
The data provide a new way of framing the health care quality issue that makes it relevant for virtually every American. As another investigator put it: ‘No one is safe from poor quality.’ How people choose to employ marketing (or not) to advance the long-term goals of policy and structural change is an open question that enterprising change agents and social marketers should revisit with a new frame being put into place. But first, let's address the question.