Is your car getting better health care than you are? For many Americans, the answer is yes, and tens of thousands of people in this country are dying needlessly each year as a result.
When you take your car in for servicing, you expect it to get all the procedures needed to keep it running. But a new RAND Health study, which I co-authored, finds that American adults are getting only 55% of the medical services they need.
Recently, I took my husband's car to a dealer he had never used. The service representative typed my husband's name into a computer and promptly called up a detailed history of all the servicing ever performed on the car. He compared what had been done to what should have been done.
He told me why the car wasn't running well — a failure to deliver needed preventive maintenance — and then recommended a way to fix it.
No one could sensibly argue that providing medical care to people is as simple as providing mechanical services to cars. But shouldn't we be using all the modern tools available to make sure more people consistently get the tests and treatments they need?
Though many doctors use the most modern medical devices and treatments, most generally fail to take advantage of the latest technology to keep track of what they have done for their patients or to share that information with other doctors and with patients themselves. Doctors rely on handwritten medical records filed in folders just as they did 100 years ago, exchange information with other doctors via mail, phone or fax and communicate with patients in quick office visits or hurried phone calls.
A patient may have three or four doctors, and each could do a better job of treating you if he or she had a detailed and updated description of all your medical conditions, test results and treatments, and if each worked as part of a team. As a patient, you could benefit by having access to your own health information (assuming it was written in plain English) so you could be part of the team.
Our study — based on reviews of medical records and interviews with nearly 7,000 adults in 12 metropolitan areas — found that the average adult received only about eight of the 16 medical services he or she needed over two years. Everyone in the study was at risk of failing to get needed services or at risk of getting unneeded and even possibly harmful medical services.
For example, people in our study with high blood pressure needed about three services on average, including recommendations about diet and exercise, appropriate medications and measuring of their blood pressure each year. They received about two of the services they needed. Poor blood pressure control, which occurs commonly in this country, contributes to about 68,000 preventable deaths each year.
How can we prevent many of these deaths? We need a system similar to the one I saw at the auto dealer to track all of the health services we receive.
Information is essential, but it isn't enough. We need a real health-care system. We need to create teams of health professionals — doctors, nurses, health educators — who work together. Those teams must have tools to help them quickly identify the best set of services for each of us. And they must be able to explain the choices we have in plain language so we can each decide what treatment is right for us.
In a few places, we see that these ideas are already taking shape. The U.S. Department of Veterans Affairs offers a model. It re-engineered its health system to improve quality and has one of the most advanced electronic medical records systems in the nation. And the veterans receive preventive services more often than what we found in our study. Unfortunately, the vast majority of people don't get health care in model systems.
It's good that mechanics can do so much to diagnose problems and service our cars. We need to put systems into every doctor's office, hospital and clinic in this country in the next few years to help professionals better diagnose and treat us all.
Elizabeth A. McGlynn is associate director of RAND Health, the nation's largest independent health policy research organization.
This commentary originally appeared in Los Angeles Times on June 26, 2003. Commentary gives RAND researchers a platform to convey insights based on their professional expertise and often on their peer-reviewed research and analysis.