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A study conducted by the RAND Corporation and funded by the Robert Wood Johnson Foundation has found that virtually every person in the United States is at risk of failure to receive needed care regardless of race, sex, income, or insurance status.


The study, published in the New England Journal of Medicine in March 2006, is the third installment of the largest and most comprehensive examination ever conducted of healthcare quality in the US.


Two previous publications from RAND Health documented that Americans receive just half of recommended care no matter where they live. The latest report represents the most comprehensive evaluation to date of the relationship between individual sociodemographic characteristics and multiple areas of quality of care. Although some disparities in care exist, they are small relative to the gap between what everyone needs and what they are receiving. It also shows that the relative performance varies by the aspect of care examined.


According to the study, which assessed preventive services and care for 30 acute and chronic conditions that constitute the leading causes of death and disability, participants received approximately 55% of recommended care. This is despite the fact that recommended care for these conditions is widely known and accepted.


Some of the study findings include the following:


* Women received a higher proportion of recommended care than did the men (57% vs 52%).


* Women were more likely than men to receive preventive services (57% vs 50%) and needed chronic care (58% vs 55%).


* Women were less likely than men to receive needed acute care (52% vs 58%).


* Younger and wealthier participants were more likely to be screened, but less likely to receive follow-up care, than older participants.


* Adults younger than 31 years were significantly more likely to receive preventive care than those older than 31 years.


* Those aged 31 to 64 years received significantly better chronic care than did those younger than 31 years (57% vs 51%).


* Those with annual family incomes of more than $50 000 had quality scores that were just 3.5 percentage points higher than those with incomes less than $15 000.


* Overall quality scores for blacks were 3.5 percentage points higher than those for whites.


* Overall quality scores for Hispanics were 3.4 percentage points higher than those for whites.


* Blacks had higher scores for treatment and for chronic care than did whites (64% and 61%, respectively, vs 56% and 55%).


* Hispanics were more likely to receive screening than were the whites (56% vs 52%).



The authors found that insurance status had no real effect on quality. Insurance "is not sufficient to assure appropriate use of services," wrote the authors. In fact, in situations where everyone has equal access, disparities in care according to race or ethnic group are often reduced or even reversed.


"The results of our study will be surprising to some people, but the findings make it clear that the quality problem affects all of us," said Elizabeth McGlynn, PhD, associate director of RAND Health and senior author of the study. "This tells us that the US healthcare system is unreliable and cannot guarantee that patients-rich or poor, white or black, insured or uninsured-will receive the right care at the right time. We need to fundamentally redesign the health system to ensure that no matter who you are or where you go for care you will get what you need."


The study used a state-of-the art methodology that involved both telephone surveys and reviews of patients' medical records from all providers seen during the 2-year study period. Nearly 7000 adults in 12 nationally representative metropolitan areas participated in the study, which evaluated performance on 439 indicators of quality care for 30 acute and chronic conditions such as urinary tract infections, diabetes, asthma, high blood pressure, and heart disease, along with preventive care.


RAND Health, a division of the RAND Corporation, is the nation's largest independent health policy research organization, with a broad research portfolio that focuses on healthcare quality, costs, and delivery, among other topics.


The Robert Wood Johnson Foundation, the nation's largest philanthropy devoted exclusively to improving the health and healthcare of all Americans, focuses on the pressing health and healthcare issues facing our country.


To view the research abstract, visit the Robert Wood Johnson Foundation Web site: