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Three AHRQ-Funded Articles Featured in JAMA Health Care Access Theme Issue

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Press Release Date: October 24, 2000

Three articles dealing with issues related to access to high-quality, cost-effective health care were funded by the Agency for Healthcare Research and Quality (AHRQ) and are featured in the October 25 issue of the Journal of the American Medical Association (JAMA). The articles offer insights into three critical health care access issues: the link between insurance coverage and quality health care; the cost-effectiveness of comprehensive neonatal follow-up care for high-risk infants; and the role of state scholarship and loan forgiveness programs on the primary care workforce.

Insurance Coverage Does Not Guarantee Access to High-Quality Health Care Services

Ensuring that Americans have insurance coverage will not necessarily ensure that they have access to high-quality health care services. AHRQ Director John M. Eisenberg, M.D., and Elaine J. Power, M.P.P, now with the National Forum for Healthcare Quality Measurement and Reporting, identified seven obstacles to guaranteeing high-quality health care. The authors explain that these obstacles are similar to "voltage drops" that may occur as electrical current passes through resistance. To ensure that all patients receive high-quality care, all of the following issues must be addressed adequately: 1) many Americans do not have access to affordable health insurance; 2) even when they are offered insurance, some do not enroll; 3) even if they have health insurance, some needed services or providers may not be covered; 4) even if services and providers are covered, patients may not be able to choose among plans, institutions, or clinicians, and thus cannot exercise their power in the market to select the care they prefer; 5) even if people have a choice of plan or provider, a consistent source of primary care may not be accessible; 6) even if primary care is available and accessible, appropriate referral services may not be; and 7) even if people have both primary and referral services, there may be gaps between the quality of care that can and should be provided and the quality of care that is delivered. "Preventing these voltage drops between insurance and quality of care will require a multi-pronged effort to ensure not only that insurance is available but also that it is taken, not only that appropriate services are covered but also that informed choices can be made, and not only that primary care and specialty services are accessible but also that quality care is delivered," the authors noted.

For more information or to schedule an interview with the authors, please contact Karen Migdail at (301) 427-1855 , or

Program of Comprehensive Follow-Up Care Reduces Life-Threatening Illnesses and Improves Outcomes for Inner City High-Risk Infants

Implementing a program of comprehensive neonatal follow-up care after hospital discharge for inner city, high-risk infants reduces life-threatening illnesses and appears to reduce costs. Sue Broyles, M.D., Jon E. Tyson, M.D., M.P.H., and colleagues at the University of Texas Southwestern Medical Center at Dallas found that, when high-risk infants received comprehensive follow-up care, 47 percent fewer of them died or developed life-threatening illnesses that required admission for pediatric intensive care. High-risk infants were defined as those weighing less than 1,000 grams at birth or those weighing 1,001-1,500 grams who required mechanical ventilation. For all care between discharge and 1 year, the estimated average cost per infant was $6,265 for comprehensive care and $9,913 for routine care.

Comprehensive follow-up care for high-risk infants was defined as 24-hour access to highly experienced care givers and 5-day-a-week follow-up care, which included well-baby care, treatment for acute and chronic illnesses, and routine follow-up care. Routine follow-up care was available 2 days per week and included well-baby care and chronic illness management.

State Primary Care Scholarship Programs Play Major Role In U.S. Health Care Safety Net

State-sponsored scholarship, loan forgiveness, and similar programs now support a primary care workforce comparable in size to that fielded by better known federal programs such as National Health Service Corps. Donald Pathman, M.D., M.P.H., and his colleagues at the University of North Carolina at Chapel Hill found that solely state-supported programs have experienced dramatic growth since the 1980s. In particular, the number of programs doubled between 1990 and 1996 to 82 programs operating in 41 states. In 1996, an estimated 1,306 physicians and 370 nurse practitioners, nurse midwives, and physician assistants provided care under obligation to these state programs, a number roughly equal to those obligated under federal programs.

According to researchers, these previously unheralded state programs are now a major portion of the U.S. health care system's safety net, and they should no longer be omitted from listings of safety net initiatives, nor overlooked in future plans to further improve health care access. In addition, Dr. Pathman and his colleagues recommend that a mechanism be established to track, evaluate, and coordinate the efforts of states, local communities, and federal programs to eliminate duplication of efforts and to prevent gaps in the health care safety net.

"State Scholarship, Loan Forgiveness, and Related Programs: The Unheralded Safety Net." For interviews with Dr. Pathman, call him directly at (919) 966-4270 or page him at (919) 216-6885.

Editor's Notes:

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