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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.

If you get sick or have surgery, you have only a 3 in 5 chance of getting the care that's recommended for you. This statement is so shocking that I wouldn't blame you for questioning it.

We have one of the most advanced health care systems in the world, with thousands of dedicated doctors and nurses and many state-of-the-art hospitals. We know that errors happen and that not everyone gets access to health care when they need it. Still, we expect that when we seek out care, we'll get the right care.

I wish that were consistently true. The fact is that U.S. patients receive the recommended care for their illness or condition only about 60 percent of the time, according to a set of new reports from my agency, the Agency for Healthcare Research and Quality (AHRQ).

The reports also show that patient safety actually is getting worse. For example, 1 in 7 hospitalized Medicare patients experiences significant harm when hospitalized, and poor, less educated and minority Americans tend to receive poorer quality of care than whites.

These reports also show that:

  • Only 40 percent of patients with diabetes got the three recommended preventive exams in the past year, a rate that has stayed the same over time.
  • Only half of obese adults and children were advised to exercise more and eat a healthy diet.
  • Seven out of 10 adults with mood, anxiety, or impulse disorders got inadequate treatment or no treatment at all.
  • Blood infections caused by catheters affect thousands of hospitalized patients each year.

We've been publishing these reports every year since 2003. I'm sorry to report that quality is improving at a very slow pace. The annual rate of improvement shown in this year's report is 1.8 percent. This is better than last year, but the pace of progress is not rapid enough to close the major gaps in quality that we've known about for well over a decade.

As a physician and as a patient, I want to see faster progress. And you should, too. We have a right to expect safer, higher quality health care.

Many health care organizations are working diligently to improve quality and safety. But change comes slowly, and improvements can be hard to sustain. In the meantime, there are things you can do as a patient to make sure you get safe, high-quality care.

The first is to ask a lot of questions. When it comes to your health care, questions are the answer. Engaging your doctor or nurse in a discussion about your condition and your care will make sure that everyone's paying attention. Simple questions—"Which hospital is best for my needs?" and "Will this medicine interact with medicines I'm already taking?"—will spark a dialogue that will help you understand your condition and choose your options.

The second thing you can do is to conduct your own research about your hospital or your condition. Medicare's Hospital Compare Web tool offers information on how your local hospitals perform when treating certain conditions, such as heart attack or pneumonia, and on other measures, including patients' experiences in the hospital.

Many States offer some type of hospital rating system or tools so you can get a sense of the quality of care a hospital provides before you walk in the door. Check with your State's insurance department or health department to find out what tools are available.

Finally, taking good care of yourself and getting the right preventive tests, like being screened for breast cancer or colorectal cancer, can increase your chances for staying healthy or catching problems early when they can be treated more effectively. It's also important to maintain your health by staying at a healthy weight, eating nutritious foods, and stopping smoking.

AHRQ's reports indicate that quality is slowly getting better, but we still have a long way to go. Health care organizations and care providers have major roles to play in improving quality and closing gaps in care access. You can help by asking questions, doing your own research, and taking an active role in maintaining your health.

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


More Information

Agency for Healthcare Research and Quality
2008 National Healthcare Quality and Disparities Reports

Agency for Healthcare Research and Quality
Questions are the Answer

Centers for Medicare & Medicaid Services
Hospital Compare

Page last reviewed June 2009
Internet Citation: New Reports Show Weak Progress on Health Quality. June 2009. 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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