Health Care Quality and Access
Despite high health care spending levels, many preventable quality problems such as health-care-associated infections continue to persist. Access to health care also continues to be a problem for certain groups.
The Department of Health and Human Services (HHS) is responsible for a variety of significant efforts that address health care quality and access.
- Measuring the quality of care across providers: HHS publicly reports quality measures, and has begun to adjust payments to certain providers based on the results. The Hospital Value-based Purchasing program provides bonuses or penalties to hospitals, which generally have been less than 0.5 percent of applicable Medicare payments per year since the program began. Clinical Data Registries can track and interpret trends in physician quality over time, and HHS needs to establish key requirements for them that focus on improving quality and efficiency. HHS measures of nursing home quality show mixed results, and HHS needs to audit quality data and monitor changes in nursing home oversight.
Figure 1: Nursing Home Consumer Complaints and Serious Deficiencies, 2005 – 2014
- Health information technology: The interoperability of electronic health information, which many view as a necessary step to improve health care, involves challenges including insufficient data standards, variation in state privacy rules, matching patients' to health records, costs, and the need for governance and trust among participants. For HHS’s electronic health records programs, HHS needs to develop a comprehensive strategy to better ensure that HHS’s future actions result in timely improvements in addressing key challenges related to the interoperability of health information.
- Access to mental health services: The federal government has more than 100 programs that can generally support individuals with serious mental illness and HHS needs to establish a mechanism to facilitate interagency coordination across these programs.
- Access to prescription drugs and preventing drug abuse: While some believe enforcement actions by the Drug Enforcement Agency (DEA) have helped decrease prescription drug abuse, some pharmacies report that stricter limits with regard to prescribing controlled substances have limited their ability to supply drugs to those with a legitimate medical need. The DEA should improve communication and guidance for providers to help ensure a better balance between access for patients with legitimate medical needs and controlling prescription drug abuse.
- Transparent information: The cost and quality of health care services can vary significantly, with high cost not necessarily indicating high quality. As consumers pay for a growing proportion of their care, they have an increased need for cost and quality information before they receive care, so they can plan and make informed decisions. HHS should take steps to improve the information in the transparency tools it provides for consumers, and develop procedures and metrics to ensure that tools address consumers' needs.
GAO-16-33: Published: Oct 30, 2015. Publicly Released: Nov 30, 2015.
GAO-16-9: Published: Oct 1, 2015. Publicly Released: Oct 1, 2015.
GAO-15-817: Published: Sep 16, 2015. Publicly Released: Sep 29, 2015.
GAO-15-113: Published: Dec 18, 2014. Publicly Released: Feb 5, 2015.
GAO-14-207: Published: Mar 6, 2014. Publicly Released: Mar 6, 2014.
GAO-17-196: Published: Dec 15, 2016. Publicly Released: Dec 15, 2016.
GAO-17-61: Published: Nov 18, 2016. Publicly Released: Dec 6, 2016.
GAO-16-700: Published: Sep 7, 2016. Publicly Released: Oct 6, 2016.
GAO-16-333: Published: Mar 29, 2016. Publicly Released: Apr 28, 2016.
GAO-16-334: Published: Mar 18, 2016. Publicly Released: Apr 14, 2016.
GAO-16-308: Published: Feb 25, 2016. Publicly Released: Feb 25, 2016.
GAO-16-189: Published: Dec 18, 2015. Publicly Released: Dec 18, 2015.
GAO-16-125: Published: Oct 15, 2015. Publicly Released: Nov 16, 2015.
GAO-15-677: Published: Jul 30, 2015. Publicly Released: Jul 30, 2015.
GAO-15-401: Published: Apr 22, 2015. Publicly Released: May 22, 2015.