Insurance coverage does not guarantee access to high-quality health care services

Ensuring that Americans have insurance coverage will not necessarily ensure that they have access to high-quality health care services. Agency for Health Care Research and Quality Director John M. Eisenberg, M.D., and Elaine J. Power, M.P.P., formerly of AHRQ and now with the National Forum for Healthcare Quality Measurement and Reporting, identified seven obstacles to guaranteeing high-quality health care.

In a recent article in the Journal of the American Medical Association, Dr. Eisenberg and Ms. Power explain that these obstacles are similar to "voltage drops" that may occur as electrical current passes through resistance. They cite the following issues that must be adequately addressed to ensure that all patients will receive high-quality care:

• 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 services or providers they need 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 care and referral services, there may be gaps between the quality of care that can and should be provided and the quality of care that is delivered.

Dr. Eisenberg and Ms. Power note that 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.

For more information, see "Transforming insurance coverage into quality health care," by Dr. Eisenberg and Ms. Power, in the October 25, 2000 Journal of the American Medical Association 284, pp. 2100-2107.

Reprints (AHRQ Publication No. 01-R005) are available from the AHRQ Publications Clearinghouse.

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