Quality of care nearly equal if access is equal

But some experts say access must be factored in because it is such a big barrier to care.

By Kevin B. O'Reilly, AMNews staff. April 10, 2006.

Once patients are in the exam room, race, income and insurance status make little difference in the quality of care patients receive from their physicians, with clinically recommended care being delivered only 54.9% of the time no matter whom the person is, according to a recent study.

Steven M. Asch, MD, MPH, a Los Angeles internist and lead author of the study that appeared in the March 16 New England Journal of Medicine, said there's no question enormous disparities exist in the U.S. health care system between black and white, insured and uninsured, rich and poor. But by only studying the records of patients who had seen a physician in the previous two years, researchers were able to exclude the access-to-care issues that so often confound other studies and focus on the quality of care patients of different backgrounds receive, Dr. Asch said.

"The first step in the health care process is getting in to see the doctor. Once you're in the door, it appears those things are less important than whether you get basic bread-and-butter medical care," he said. "Once in the door, it seems like we're all in the same boat and we get approximately the same level of recommended care."

Dr. Asch and his co-authors studied nearly 7,000 patients' medical records covering a four-year period.

It is the third study stemming from a RAND Health examination of the care recommended to patients in 12 cities between 1996 and 2000. The first, published in 2003, established that across 439 quality indicators developed by a panel of medical society experts for 30 acute and chronic conditions ranging from asthma to urinary tract infections, patients only received recommended care a little more than half the time. A follow-up study examined the same data to determine that where patients lived had no effect on the quality of care received.