Washington, D.C. 20037-1270
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Contact:
Jess Cook
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Fax: 310-451-6988
A NOTE TO REPORTERS COVERING HEALTH CARE ISSUES
The enclosed essay appearing in the new issue of Health Affairs, "Perspectives on Medicare," is about much more than the title indicates. It is the best synthesis I have seen to date of the state of knowledge and practice concerning quality of care in general and how this relates to the nation's headlong drive to slow the growth of public sector health care spending, expand the reach of managed care and reduce health care costs overall.
The author, Dr. Robert Brook, has pioneered efforts to measure, and thereby improve, quality of care. He is the director of RAND's Health Sciences Program and a professor of medicine and health services at UCLA.
"The mean level of the quality of care in today's health care system is not high, and variations in the level of quality are substantial," he writes. "Perhaps one-quarter of what is done is inappropriate, and perhaps one-quarter of all hospital deaths are preventable." Making cost-focused changes in the system while ignoring these clinical issues will be dangerous, he warns: "Necessary services will decline as rapidly as unnecessary services, and centers of excellence will decline as rapidly as mediocre facilities."
Brook finds reason for optimism. It is possible to contain costs by reducing waste, to define what constitutes necessary care, and to ensure that those who provide care do it well, he maintains. But to achieve these goals, patients, physicians and the public will all have to accept new responsibilities.
I think you'll agree that this succinct, cogent article is well worth a ten minute investment in reading time.