One phrase heard time and again in the debate on healthcare reform and the Affordable Care Act is quality of care. But what does that term really mean for patients? Most of us assume we’re getting quality care every time we see our doctor or go to the hospital for an emergency. And yet even though the United States spent $2.5 trillion on health care in 2009—more than any other country—the Institute of Medicine (IOM) tells us the outcomes of our care weren’t as good as they should be. How will the Affordable Care Act address this problem?
IOM is a branch of the nongovernmental National Academy of Sciences that provides nonpartisan information and advice on health issues. According to its 2001 report “The Quality Chasm: A New Health System for the 21st Century,” quality care is a commitment on the part of all of us—patients, providers, legislators, and industry—“to continually reduce the burden of illness, injury, and disability, and to improve the health and functioning of the people of the United States.” The report states that quality care is achieved by a health care system that is
- Safe: avoiding injuries to patients from the care that is intended to help them.
- Effective: providing services based on scientific knowledge to all who could benefit, and refraining from providing services to those not likely to benefit.
- Patient-centered: providing care that is respectful of and responsive to individual patient preferences, needs, and values, and ensuring that patient values guide all clinical decisions.
- Timely: reducing waits and sometimes harmful delays for both those who receive and those who give care.
- Efficient: avoiding waste, including waste of equipment, supplies, ideas, and energy.
- Equitable: providing care that does not vary in quality because of personal characteristics such as gender, ethnicity, geographic location, and socioeconomic status.
One way the Act reflects these goals is to require insurers to spend 80 to 85 percent of your health insurance premium dollars on health care and quality improvement or give you a rebate. The Act also works toward improving the quality of care by strengthening the nation’s network of community health centers and testing new methods for delivering services, for example, coordinating care among physicians and community resources. (Visit http://innovations.cms.gov/ for more information on the Center for Medicare & Medicaid Innovation and its mission to improve quality of care and reduce rising healthcare costs.)
The new law also sets out to improve quality of care in two other significant areas:
- Emphasis on Prevention —The Act sets the stage for a significant shift in behavior and thinking about how we deliver and pay for health care. If we take the time and money when we’re well and invest it in staying well, we may be able to avoid or lessen the impact of many diseases and their accompanying costs.
- Health Homes —These provisions focus on providing and coordinating care within your community as an alternative to institutional care.
By insisting on accountability and providing incentives, the intent of the new law is to reward doctors who successfully coordinate patient care, improve quality, stress prevention, and reduce the number of hospital admissions.
Consumer Resources
Government websites and others offer many tools and other resources to help you understand and benefit from the Affordable Care Act: