Part 1. AHRQ Activities and Accomplishments, FY 2002

Health Care in America

Over the last century, Americans have experienced unprecedented advances in health care. Average life expectancy has increased by nearly 30 years, and as a nation, we are enjoying healthier and more productive lives. We are moving closer every day in our quest to find new treatments and cures for diseases that affect millions of Americans.

Much of this progress is due to the advances that have emerged from our investments in health care research. These investments have led to a strong foundation of scientific evidence that has been accumulated over time from many sources. These include basic science carried out in laboratories, clinical trials underway in hospitals and other health care settings, and health services research that is conducted by investigators in both clinical and nonclinical settings.

As a result, the health care we receive today may be the most technologically sophisticated and highest quality care in the world. However, as we move ahead in this new century, it has become apparent that the care known to be effective is not always the care we receive. Indeed, all too often health care causes harm. One recent report concluded that tens of thousands die each year from errors in their care. Indeed, medical errors could be among the top 10 causes of death in the United States.

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Addressing Health Care Challenges

Today, we are experiencing an unprecedented volume and pace of change in the U.S. health care system. These changes are not occurring uniformly across the country, and they affect different population groups in different ways.

While medical science and technology continue to provide promising advances, our health care system often struggles to keep up and deliver those advances to patients in the form of improved health care. Recognizing this, the Institute of Medicine recently reported that "between the health care we have and the care we could have lies not just a gap but a chasm."

The urgency for addressing the issues underlying this chasm has increased as a result of events that occurred in the aftermath of September 11. We must find ways to respond quickly and efficiently to threats of bioterrorism and other public health emergencies.

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Moving Ahead in a New Century

In this first decade of the 21st century, we continue to search for answers to questions about patient safety and medical errors, escalating health care costs, a vulnerable population of uninsured Americans, problems in accessing care, and disparities in care and outcomes that are related not only to insurance, but also to race, sex, age, health status, and geographic location.

Over the last quarter of the 20th century, health care in the United States began to move away from a disease-centered model toward a patient-centered model, in which patients and consumers have more information about their diseases and treatment options and play a more active role in their own care. Yet, patients do not always have the tools and information they need to help them decide among treatment options. Likewise, consumers and patients need information to help them choose high quality care, compare health plans, and avoid medical errors.

Research to address these and other pressing concerns is central to the mission of the Agency for Healthcare Research and Quality. A key component of the agency's mission is to ensure that the knowledge gained through research is translated into measurable improvements in the health care system. Our most important goal is to work toward high quality, accessible, and affordable health care for all Americans.

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AHRQ: Working to Improve Health Care in America

AHRQ supports and conducts health services research on health care quality, patient safety, access to care, medical effectiveness, the costs of care and how we pay for care, and many other issues that are crucial to the future health and well being of the American people.

This report presents information on the programs and activities undertaken by AHRQ in FY 2002. It includes examples of some recent accomplishments and a description of the research priorities that will shape our activities in the months ahead. To set the stage for this discussion, the report describes AHRQ's organizational structure and the key responsibilities of functional components (see appendixes A and B), discusses the role of the agency's National Advisory Council (see appendix C), and identifies the various audiences and customers who use and depend on the findings from agency-supported research.

Findings from AHRQ's Medical Expenditure Panel Survey (MEPS) and Healthcare Cost and Utilization Project (HCUP), as well as other sources, provide a snapshot of health care in America today. For example:

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Health Care Costs and Sources of Payment

• According to the MEPS, health care expenditures for the community (noninstitutionalized) population in the United States accounted for nearly $600 billion in 1999.
• Just 1 percent of America's community population accounted for 27 percent of all U.S. health care expenditures in 1996. This concentration of expenditures was remarkably consistent with the distributions observed in both 1977 and 1987.
• Approximately 84 percent of the U.S. community population has at least some medical expenses during a year. In 1999, the average expense per person for those individuals was just under $2,600, up from $2,444 in 1998.
• Overall, most expenses for the community population are covered by private insurance. In 1999, for example, about 40 percent of all expenditures for people living in the community were paid by private insurance.
• Approximately one-fifth of expenses for the community population are paid out of pocket. In 1999, for example, about 19 percent of all expenditures for this population were paid out of pocket, 23 percent were paid by Medicare, and 9 percent were paid by Medicaid.
• In 1999, only 56 percent of the uninsured community population had any medical expenses, compared with 87 percent for those with private insurance. Medical expenditures for the uninsured are largely, but not exclusively, paid out of pocket.

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Health Insurance

• In 2001, 18.8 percent of the U.S. population under age 65 were uninsured, and 12.1 percent had public coverage only.
• Hispanics under age 65 were more likely than people of other races to be uninsured in 2001. Nearly 38 percent of Hispanics lacked either public or private insurance in 2001, compared with 20.2 percent of blacks and 14.9 percent of whites.
• There was a difference between people under age 65 who were employed (17.7 percent) and those who were not employed (28.0 percent) in lack of health insurance in 2001.
• Because part-time workers are less likely to be offered employment-related health insurance, they are much more likely than full-time workers to be uninsured. From 1996 to 2001, part-time workers were about 8 to 10 percentage points more likely to be uninsured than full-time workers.

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Health Status

• Among Americans aged 18 and older in 2000, 23 percent said they have high blood pressure; 10.3 percent reported that they have heart disease; 9.1 percent reported that they have asthma; and 6.2 percent said they have diabetes.
• Both Hispanics and blacks aged 18 and older were more likely than whites and people of other races to report having diabetes.
• Heart attack and hardening of the arteries of the heart were among the top 10 diagnoses for both male and nonobstetric female hospital discharges in 2000.
• Hospital discharges for mood disorders (primarily depression) have risen steadily, from 485,000 in 1993 to 664,000 in 2000, an increase of over 35 percent.
• Among both men and women aged 18 to 64 who were hospitalized in 2000, obesity was a coexisting medical condition that could have complicated the care they received in the hospital, which may lead to longer stays and worse outcomes.
• Depression was the most common reason for nonobstetric hospital stays among women aged 18 to 44 in 2000.
• About 4.4 million hospital discharges in 2000 were related to obstetric conditions.

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Use of Health Care

• In 2000, 72.3 percent (145.5 million) of the U.S. population aged 18 and older had visited a doctor or medical clinic in the previous 12 months.
• In 2000, nearly 97 percent of people 18 and older who reported having a stroke reported having their blood pressure checked in the past year, and close to 60 percent were told to moderate their diet or increase their level of physical activity. Stroke survivors aged 18-64 were less likely than those 65 and older to report having a routine check-up within the past 12 months.Control of blood pressure is essential to decreasing the recurrence of stroke.
• Trend data show that patients hospitalized in 2000 spent nearly 20 percent less time in hospitals, on average, than patients in 1993. Despite decreased use of the hospital, however, hospital costs now are the most rapidly rising component of health care expenditures. Go to www.hschange.org for more information.
• Pregnancy and childbirth account for nearly one of every four hospital stays for women.
• Diseases of the circulatory system (e.g., heart disease) were the most common reason for hospitalization for both men and women (excluding obstetric conditions) in 2000, followed by diseases of the respiratory, digestive, and musculoskeletal systems.

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Access to Care

• In 2000, 34.4 percent of the U.S. civilian community population aged 18 or older reported that they had an illness or injury for which they needed medical care right away. Just over half of those saying they needed urgent care said they always received care as soon as they wanted
• Among people 18-64 years of age, whites were more likely than Hispanics to say they needed urgent care (34.7 percent and 29.1 percent, respectively). Among those needing care, whites were more likely than Hispanics to say they always received care as soon as they wanted
• Among people 18-64 years of age, the uninsured were more likely than those with insurance to report sometimes or never receiving urgent care as soon as they wanted (uninsured, 28.6 percent; public insurance, 19.1 percent; and any type of private insurance, 16.1 percent).

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Health Care Disparities

• Among people aged 18-64 receiving care in 2000, those with private insurance (84.5 percent) were more likely to say that they did not have problems in getting needed care, compared with those who had only public coverage (71.5 percent) and the uninsured (72.9 percent).
• Among people visiting a doctor or medical clinic in 2000, blacks (64.4 percent) were more likely than whites (58.6 percent) or Hispanics (53.1 percent) to say their providers always explained things in a way they could understand.
• The proportion of hospital stays involving cardiac bypass surgery is over 50 percent higher for men than for women. Also, women are 12 percent less likely than men to undergo diagnostic cardiac catheterization or coronary arteriography while in the hospital following a heart attack.

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