Improving the Quality of U.S. Health Care - What Will It Take?

The Covid-19 pandemic has brought to light long-standing quality deficiencies within U.S. health care, building on a 2003 report that found U.S. adults received, on average, only 55% of recommended medical care. Despite nearly two decades of various interventions, including standardized measurement, public reporting, and incentive programs, the average quality performance remains largely unchanged. High-quality health care is defined as increasing the likelihood of desired health outcomes, consistent with current professional knowledge, as outlined by Avedis Donabedian's enduring framework of structure, process, and outcomes. The article uses the example of hypertension management, a common and treatable condition, to illustrate how improving care quality can lead to reductions in critical events like heart attacks and strokes. The challenges to enhancing quality are complex, stemming from the intricate nature of the U.S. health care system, misaligned incentives, and a lack of accountability. Nevertheless, the present moment, as the nation addresses the pandemic's impact and confronts structural racism and inequities, offers a crucial opportunity to invest in quality to establish a foundation for a healthier America.

The Covid-19 pandemic has brought to light long-standing quality deficiencies within U.S. health care, building on a 2003 report that found U.S. adults received, on average, only 55% of recommended medical care. Despite nearly two decades of various interventions, including standardized measurement, public reporting, and incentive programs, the average quality performance remains largely unchanged. High-quality health care is defined as increasing the likelihood of desired health outcomes, consistent with current professional knowledge, as outlined by Avedis Donabedian's enduring framework of structure, process, and outcomes. The article uses the example of hypertension management, a common and treatable condition, to illustrate how improving care quality can lead to reductions in critical events like heart attacks and strokes. The challenges to enhancing quality are complex, stemming from the intricate nature of the U.S. health care system, misaligned incentives, and a lack of accountability. Nevertheless, the present moment, as the nation addresses the pandemic's impact and confronts structural racism and inequities, offers a crucial opportunity to invest in quality to establish a foundation for a healthier America.