Health Care Quality, Geographic Variations, and the Challenge of Supply-Sensitive Care

THE UNITED STATES SPENDS MORE per capita on health care services than any other country, yet there are mounting concerns about the uneven and unpredictable quality of care provided at even the "best" American institutions. In 1998, the National Roundtable on Health Care Quality reported serious and widespread quality problems throughout the American health care system, regardless of organizational setting or payment mechanism (Chassin and Galvin 1998). A review of published studies indicated that, on average, 50 percent of patients did not receive recommended preventive care; 30 percent did not receive needed care for acute medical conditions, and 40 percent went without necessary care for chronic conditions (Schuster, McGlynn, and Brook 1998). An Institute of Medicine (2001) panel concluded that safe and error-free delivery of effective care will require a fundamental redesign of the health care system.