Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

Former AHRQ Director Carolyn Clancy, M.D., prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan.

If you've ever thought that your experience with the health care system–good or bad–is very different from someone else's, you're not alone.

A new set of reports from the Agency for Healthcare Research and Quality (AHRQ) show that the goal of safe, high-quality care is not within reach for all Americans. The 2012 National Healthcare Quality Report and National Healthcare Disparities Report were released this month.

Based on data collected from 2002 to 2009, the reports found that we get the right treatment for our particular condition or our age only 70 percent of the time. And 26 percent of Americans said they face some kind of barrier to getting health care services. This is especially true for people who are in racial and ethnic minority groups, or who have low incomes.

On the plus side, we are making progress in important areas.

Overall, the quality of care that patients get from their doctors and in hospitals is slowly improving. Some areas that got better include making sure that surgical patients got antibiotics at the right time. And patients in the hospital more often got a flu or pneumonia shot if they needed one.

Checklists that remind a health care team what to do and when to do it are also showing results. These improvements help patients recover faster and also lower the cost of care by preventing complications or longer hospital stays.

But there's a lot more work we have to do.

We need to focus on making sure that patients with certain conditions, such as diabetes, pressure ulcers, and risk of blood clots, get the care they need. We also need better care for new mothers and children.

Diabetes is a serious condition, that left untreated, can lead to side effects that include blindness, heart disease, and a shorter life. Yet the reports found that 23 percent of adults age 40 and older with diabetes got all 4 of the recommended services they need each year. Black and Hispanic adults with diabetes were less likely to receive the recommended care.

As a result of not getting the right care, hospital stays for uncontrolled diabetes were about four times higher for low-income groups, and about three times higher for blacks than for whites.

But things are starting to happen that could point these trends in the right direction.

The first is the Affordable Care Act (ACA), which is increasing access to care for millions of Americans. (The data from the reports were collected before the ACA, which is aimed at addressing many quality and access issues).

Already, the ACA has improved access to care for more than 3 million young adults who can stay on their parents' health insurance plans until age 26. Starting in October, Americans who don't have health insurance through their jobs will be able to buy it through state-run exchanges that will offer different options.

The second is changes in the ways that some health systems are working with patients to help them better manage chronic diseases. For example, Advocate Health Care, a system outside of Chicago, has hired care coordinators to talk frequently with these patients. It also gives doctors report cards on how their patients are doing. Advocate is an accountable care organization, a new approach that was created under the ACA.

I'm confident these changes will have a positive effect on access and quality of care.

But just as important, you have a big role to play as a patient or caregiver. Make sure you ask your health provider questions and find out what you need to do to stay healthy. AHRQ has many resources to help you do that.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

Resources

Agency for Healthcare Research and Quality
2012 National Healthcare Quality Report and National Healthcare Disparities Report
http://www.ahrq.gov/research/findings/nhqrdr/index.html

Standard Written Checklists Can Improve Patient Safety During Surgical Crises, Press Release, January 16, 2013
http://www.ahrq.gov/news/newsroom/press-releases/2013/checklistpr.html

Questions are the Answer
http://www.ahrq.gov/patients-consumers/patient-involvement/ask-your-doctor/index.html

Advocate Health Care
Advocate Health Care's Clinical Integration Program continues to garner national interest. Press release, April 30, 2013.
http://www.advocatehealth.com/body_full.cfm?xyzpdqabc=0&id=12&action=detail&ref=260  

Page last reviewed May 2013
Internet Citation: Hopeful Signs on a Long Road to a Better Health System. May 2013. Agency for Healthcare Research and Quality, Rockville, MD. http://www.ahrq.gov/news/columns/navigating-the-health-care-system/051013.html