Medical "Quality Gaps" Cause 57,000+ Deaths Annually

October 6, 2003

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A new study finds that more than 57,000 people die each year because they do not receive the care that medical authorities know they need.

The annual "State of Health Care Quality" report from the National Committee for Quality Assurance (NCQA) finds that the nation’s health care system is riddled with "quality gaps" that prevent millions of Americans from receiving "best practice" care.

"It’s not a question of knowing how to treat heart disease, diabetes or mental illness," said NCQA President Margaret E. O’Kane. "We know how. We’re just not doing it. We’re literally dying, waiting for the practice of medicine to catch up with medical knowledge. More than 57,000 people will die this year because there is a huge gap between what we know and what we do."

The gaps are the result of such factors as poor use of technology and irrational payment systems.

The report also documents the enormous financial toll of commonplace failures to deliver appropriate care: nearly 41 million sick days and more than $11 billion in lost productivity could be avoided annually if well known "best practices" were more widely adopted.

The observed "quality gaps" were not equally prevalent throughout the system -— among health plans that measure and report on their performance, clinical quality was higher and showed strong gains. This marks the fourth year that the report found that among health plans that publicly reported their performance data, clinical care improved in most areas.

The avoidable deaths come not as a result of error, but of omission. For a variety of reasons, many Americans do not receive care that medical science has shown to be effective in controlling existing conditions, such as high blood pressure and diabetes, and in preventing others, such as smoking-related heart disease.

The quality gaps lead to enormous variations in the rates at which certain important therapies or services are delivered. For example, nationwide only about 40 percent of the 31 million Americans with diagnosed high blood pressure have their blood pressure adequately controlled. An increase to 68 percent (the level already achieved by the nation’s top health plans) would save an estimated 28,000 lives next year.

The loss of life is compounded by the financial costs the nation pays for these unnecessary gaps in care. Hospitalizations due to avoidable second heart attacks cost the American economy more than $1.6 billion a year.

One of the reasons for the failure to apply best practice care is that current payment systems actually discourage it. Physicians and hospitals are compensated based on the amount of care they provide, thus discouraging the use of new treatments and therapies that may send patients home sooner. Even serious medical errors may be financially rewarded if, as is often true, they justify additional charges.

"We’re throwing up roadblocks to quality, when we should be giving out rewards," said David F. Durenberger, former United States Senator (R-Minn.) and Chairman and CEO of the National Institute of Health Policy (NIHP). "We have to start asking, ‘What are we buying?’"

The gap between best practice care and the care that many patients receive is a serious business concern as well. "This report underscores that employers and consumers are not getting the quality of health care we’re paying for," said Peter V. Lee, J.D., President and Chief Executive Officer, Pacific Business Group on Health. "The path to saving lives and money lies not in finger-pointing, but in finding out who’s doing it right, and sharing that information with those who want to do it better."

The complete text of the report is available online.

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