Aetna 2004 Annual Report Download - page 18

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Transparency: The Key
to Curing Underuse
ELIZABETH A. MCGLYNN, PH.D.
Associate Director, RAND Health
American adults receive about half of recommended health care
services for common chronic and acute health care problems.
Although adults receive some services they do not need, they more
often fail to receive services that they do need. These failures have
significant consequences for their health and well-being.
For example, we found nationally that 40 percent of people with
diabetes had not had their blood sugar measured in two years. This
test is essential for monitoring whether treatment is effective. Among
those who had been tested, nearly one-quarter had blood sugar levels
that were excessively high, and we observed a change in treatment
for those patients less than 40 percent of the time. People with
diabetes whose blood sugar levels are not controlled are at risk for
serious and life-threatening complications. We estimate that the
underuse of effective treatments may contribute annually to nearly 2,600 cases of preventable
blindness and 29,000 cases of preventable kidney failure.
Similarly, we found that persons with new diagnoses of high blood pressure were usually not
counseled to exercise or modify their diets; these actions can help patients with mild problems
avoid taking medications. Medications were prescribed only about 60 percent of the time when
necessary. About 60 percent of patients had blood pressures that were abnormally high, which
contributes to nearly 68,000 preventable deaths annually.
So what can be done? We need information systems that facilitate proactive rather than reactive
management of patients. We need to implement protocols that allow other members of the health
care team to routinely administer indicated care (e.g., flu shots, pneumococcal vaccines). We need
to engage physicians in identifying problems and taking ownership for solving those problems.
We need to activate patients to take responsibility for their own health and advocate for their health
care needs.
Transparency through public reports on quality is the key to making all of these things happen.
Transparency stimulates critical dialogue among administrators, physicians, nurses and other
health professionals about how they can redesign systems to improve performance. Transparency
encourages consumers to educate themselves about their own health care needs because it makes
clear the deficits in the system. That awareness in turn makes it acceptable for patients to talk to
their doctors about whether and how their needs will be met. Dialogue leads to action, and action
leads to improvement. We are spending nearly $2 trillion on a system that is functioning
suboptimally. We can’t afford not to act.
Transparency
encourages consumers
to educate themselves
about their own health
care needs because it
makes clear the
deficits in the system.