Healthcare Glossary

Quality Quest for Health of Illinois

The State of Healthcare Today

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Many Americans know that healthcare is expensive, but they are not sure about other reasons why healthcare reform is necessary. The biggest issues in the healthcare system today are:

  • Cost
  • Access
  • Quality issues
  • Waste of resources

High costs

The high cost of healthcare gets the most attention, and for good reason. Healthcare costs currently make up 17 percent of the gross domestic product and America spends almost twice as much per person as the next leading country. Many factors continue to drive up these costs. One key factor is that physicians are paid for the number of services they deliver, rather than for improving their patient's health. In addition, our current system focuses more on treatment than prevention, even though preventive care is cheaper than advanced treatment. As our nation switches to more preventive care, healthcare costs should decrease.

Access to care

A second serious problem with the healthcare system is that many do not have access to it. Currently, about 50 million Americans are without health insurance. Part of the problem is that we put individuals into categories to figure out how they will be covered.

  • Employed people may get health benefits from their employer.
  • People over the age of 65 are covered by Medicare.
  • Some people with low incomes—but not all—are covered by Medicaid.
  • Some of those who don't fit into any categories may receive coverage from their state.

Those without coverage may purchase a private policy or go without insurance. Private policies are expensive, and as a result, many people go without insurance. Then when they get sick, they don't go to the doctor because they can't afford it. Or they go to the emergency room, which drives up costs.

Quality

An overlooked problem of our healthcare system is the quality of care consumers receive. A RAND study found that only 2.5 percent of Americans get all the care recommended for their age, gender and personal history. The other 97.5 percent of the population does not get the care they need. This is often referred to as underuse.

Overuse in healthcare is also a problem. In this case, patients receive care that they don't need and that doesn't help them. This results in unnecessary costs to patients. Another issue is misuse—preventable errors that cause thousands of avoidable deaths each year.

Waste

Waste is a big contributor to the poor state of healthcare. Waste is highly related to overuse. Providing unnecessary care, which also increases patient costs, accounts for an estimated $700 billion each year. This amounts to about 30 percent of total healthcare spending that could be eliminated. Waste also comes from administrative costs and inefficiency. Electronic medical records can help relieve problems with keeping track of patient records, tests and imaging results.

A quest for solutions

Many problems have contributed to the poor state of healthcare that exists today, especially the cost, access, quality issues and waste in the system. Quality Quest for Health of Illinois is finding ways to improve healthcare in our state.


Benefits are what insurance pays to cover consumer health services.  A Benefits package specifies what services and products an insurance plan will pay for and plans typically offer several different benefit packages at different costs.  The word "Benefits" can also mean the good results of a treatment or lifestyle change.
Medicare is a national health insurance program for people age 65 or older that is paid for by the federal government.  Medicare has four parts.  Part A helps cover the basic costs of medical care, surgery, and mental hospital care.  Part B is extra insurance, and while the government pays for part of it people in the program pay insurance premiums, too.  Part C is a choice to get Parts A and B through a private insurance plan.  Part D helps cover prescription drug costs.  Medicare is considered an entitlement program, since anyone age 65 or older is eligible, and currently covers over 40 million people in the United States.
Medicaid is a health insurance program for lower-income families and the disabled.  It is paid for partly by the federal government and partly by the state in which an individual resides.  The criteria for Medicaid eligibility vary by state.
Underuse refers to the failure to provide a health care service when it would have produced a favorable outcome for a patient. Standard examples include failure to provide appropriate preventive services to eligible patients (e.g., Pap smears, flu shots for elderly patients, screening for hypertension) and proven medications for chronic illnesses (steroid inhalers for asthmatics; aspirin, beta-blockers and lipid-lowering agents for patients who have suffered a recent myocardial infarction).
Overuse describes a process of care in circumstances where the potential for harm exceeds the potential for benefit. Prescribing an antibiotic for a viral infection like a cold, for which antibiotics are ineffective, constitutes Overuse. The potential for harm includes adverse reactions to the antibiotics and increases in antibiotic resistance among bacteria in the community. Overuse can also apply to diagnostic tests and surgical procedures.
Misuse occurs when an appropriate process of care has been selected, but a preventable complication occurs and the patient does not receive the full potential benefit of the service. Avoidable complications of surgery or medication use are Misuse problems. A patient who suffers a rash after receiving penicillin for strep throat, despite having a known allergy to that antibiotic, is an example of Misuse. A patient who develops a pneumothorax after an inexperienced operator attempted to insert a subclavian line would represent another example of Misuse.
Overuse describes a process of care in circumstances where the potential for harm exceeds the potential for benefit. Prescribing an antibiotic for a viral infection like a cold, for which antibiotics are ineffective, constitutes Overuse. The potential for harm includes adverse reactions to the antibiotics and increases in antibiotic resistance among bacteria in the community. Overuse can also apply to diagnostic tests and surgical procedures.