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Navigating the Health Care System

Advice Columns from Dr. Carolyn Clancy

Former AHRQ Director Carolyn Clancy, M.D., prepared brief, easy-to-understand advice columns for consumers to help navigate the health care system. They address important issues such as how to recognize high-quality health care, how to be an informed health care consumer, and how to choose a hospital, doctor, and health plan.

Walk into many stores and you're bound to be impressed by the quality of digital cameras, TVs, cell phones, and other consumer electronics. Every year, the quality of these devices improves by leaps and bounds, and consumers often pay less as products improve.

I wish the same could be said about the quality of the health care in America. A new report from my agency, the Agency for Healthcare Research and Quality (AHRQ), found that we—patients, doctors, hospitals, nursing homes, health insurers, and others—are taking only baby steps when it comes to making health care safer and more effective.

Our 2007 National Healthcare Quality Report found that overall quality improved by an average of 1.5 percent per year between 2000 and 2005. This shows that the quality of health care—which ranges from treating diabetes to protecting patients from medical errors—is just not improving fast enough.

A sister report, the 2007 National Healthcare Disparities Report, also shows what many of us already know: Poor Americans and minorities often receive lower quality care. This can happen when people don't have health insurance. Because they don't have regular doctors or get needed tests, by the time they get treatment, their medical conditions may have gotten much worse.

Here are some other important facts from both reports:

  • Only 70 percent of low-income people have health insurance compared with 94 percent of high-income people. While 10 percent of whites under 65 didn't have insurance for all of 2004, this figure was 28 percent for Hispanics, 15 percent for blacks, and 12 percent for Asians.
  • People without insurance were less likely to get recommended care. For example, 74 percent of women with private insurance received mammograms in the past 2 years compared with 38 percent of uninsured women. Fifty-one percent of people with private insurance went to the dentist at least once in the previous year compared to 18 percent of people without insurance.
  • The health care system is getting safer, but it is improving only at a rate of about 1 percent a year. This estimate comes from looking at many safety issues, such as how many older patients were prescribed medicines that might be harmful or how many patients developed problems after surgery.

Our reports found some good news, too. For example, in 2005 more than 93 percent of heart attack patients received recommended care in the hospital. And the percent of heart attack patients who were advised on how to quit smoking went up to 91 percent in 2005.

As a doctor, I know that improvements in high-tech gadgets are not the same as those in health care. Changing our health system involves millions of people working together. Improving quality takes education, a willingness to admit mistakes, and teamwork.

That's where you, as an involved patient, play an important role. AHRQ offers resources on our Web site, such as how to be an active health care consumer, that can help you learn what questions to ask. Working with your doctor is an important way to become part of your health care team and can help improve the quality of your care.

We have a lot of work to do to make health care better. We need you to be involved and to help bring about the improvements in health care we are all seeking.

I'm Dr. Carolyn Clancy, and that's my advice on how to navigate the health care system.

More Information

AHRQ Podcast
Dr. Clancy Reviews the Results of AHRQ's 2007 Healthcare Quality and Disparities Reports  (Transcript)

2007 National Healthcare Quality Report
Annual report on the quality of U.S. health care

2007 National Healthcare Disparities Report
Annual report on disparities in U.S. health care

Be An Active Health Care Consumer
Information to help you participate in your health care

Page last reviewed March 2008
Internet Citation: Big Strides, not Small Steps, Needed to Boost Health Care Quality. March 2008. Agency for Healthcare Research and Quality, Rockville, MD.


The information on this page is archived and provided for reference purposes only.


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