||Insurance Coverage Does Not Guarantee Access To High-Quality Health Care Services|
Seven Obstacles To Guaranteeing High-Quality Health Care
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:
- Many Americans do not have access to affordable health insurance.
- Even when they are
offered insurance, some do not enroll.
- Even if they have health insurance, some needed services or providers may not be covered.
- 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.
- Even if people have a choice of plan or provider, a consistent source of
primary care may not be accessible.
- Even if primary care is available and accessible, appropriate
referral services may not be.
- Even if people have both primary and referral services, there may be
gaps between the quality of care that can and should 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.
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Editor: Susan K. Boyer, RN
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