Health care is improving, but prevention still lacking

Andrew Bridges

WASHINGTON — Millions of Americans aren’t following the adage: Prevention is the best medicine.

The nation’s minorities, poor and uninsured are missing out on the preventive screening and counseling they need, according to government reports released last week.

Overall, the quality of the U.S. health care system continues to improve at a modest pace. When it comes to preventive care, though, the rate of improvement lags.

Americans as a whole largely are not getting the tests, exams and advice from doctors that can lessen the burden from asthma, cancer, diabetes and obesity, according to the fourth annual national health care quality and disparities reports.

“It’s encouraging to learn that overall quality continues to improve,” said Dr. Carolyn Clancy, director of the federal Agency for Healthcare Research and Quality, which issued the two reports. “At the same time, the message is clear: Much more can be done to prevent illness from occurring or progressing.”

There also continues to be a wide split in access to health care, with poor and minority patients generally receiving poorer care, according to the reports. The uninsured, however, fare the worst when it comes to access to and quality of health care.

Finding ways to reduce the numbers of the uninsured will be a hot topic during the current Congress. Lawmakers, physician groups, insurers and others have put forth plans to cut their ranks.

The disparity findings of the congressionally mandated reports are consistent with previous editions. That divide is especially stark when it comes to preventive care, according to the new reports.

Obese blacks and Mexican Americans, for example, are less likely to be told by a doctor that they are overweight than are white patients. Anyone who’s obese — that’s about one-third of all American adults — faces an increased risk of diabetes, high blood pressure, stroke, heart disease and other serious conditions.

Identifying disparities is an important step, but closing the gaps remains a challenge, said Andrea Kabcenell, an executive director with the nonprofit Institute for Healthcare Improvement.

“It isn’t [that] we don’t know what to do, it’s [that] we don’t know how to do it,” said Kabcenell, whose institution has pushed hospitals to implement proven lifesaving strategies. “If we can show health care organizations how to do the things that reduce disparities, they will jump on them. Nobody wants these disparities.”

Among other disparities, blacks with asthma are less likely to receive medications to control their condition. And colorectal screening rates are lower for blacks and Asians when compared with whites, according to the reports.

Overall, only about 52 percent of American adults reported receiving a colorectal screening as recommended, according to the reports. Each year, there are about 150,000 new cases of colorectal cancer and 56,000 deaths. Federal health officials urge adults 50 and older to get an initial screening. The American Cancer Society estimates wider screenings could cut colorectal cancer cases and deaths in half.

“The news is encouraging in that we seem to be increasing screening rates for many populations, but there’s still a tremendous amount of work to be done and far too many people are dying of this disease,” said Dr. Durado Brooks, director of colorectal cancer for the society.

Despite recommendations that obese Americans receive diet counseling and other help, fewer than half of all severely overweight adults report getting any such advice, according to the reports.

The numbers are similar for diabetes, as just 48 percent of adult diabetics reported receiving blood sugar tests and exams of the feet and eyes. The three tests together can help prevent complications of the disease, including blindness and amputations.

Hospitalizations related to those complications cost the health care system $2.5 billion a year, according to the Agency for Healthcare Research and Quality.

(Associated Press)