Medically Reviewed On: July 21, 2008

ANNOUNCER: Many Americans might be surprised to learn that there’s a 50/50 chance they do not always receive quality health care.

CAROLYN CLANCY, MD: We know from a number of studies that Americans, on average, receive just over half of recommended care when they see clinicians. And we know that it actually doesn't matter where you live. Care doesn't vary all that much across the country in terms of a gap between best possible care and the care that people routinely receive.

ANNOUNCER: One problem is that how doctors get paid is out of sync with practices that might reward better care.

CAROLYN CLANCY, MD: One of the big, big issues in quality of care has to do with how we pay for care. In general in this country, we pay more if doctors do more. And not surprisingly, that means they do a lot.

ANNOUNCER: The problem is very evident in treating diseases like diabetes or heart disease.

REED TUCKSON, MD: People with chronic diseases require a variety of services, not the least of which is the opportunity to spend time with a physician who is listening and thinking about how to prevent disease, how to prevent complications from disease, how to be able to help better manage it in a more holistic and comprehensive way. Unfortunately, the delivery system is much more favorably inclined to reward interventions that are procedural, doing things, applying technology, putting wires into hearts, doing surgeries, those sorts of things.

ANNOUNCER: Employers and insurance companies are beginning to make changes, to reward better care.

CAROLYN CLANCY, MD: A number of private sector employers have actually stepped up to say, "There is something wrong with this picture. We think that we could actually come up with a different program that says, 'We'll pay you more if you achieve certain quality goals.'"

ANNOUNCER: Experts say improving the quality of health care often saves money.

CAROLYN CLANCY, MD: There are many examples where improving quality of care actually leads to savings. For example, better care for diabetes can often prevent unnecessary hospitalizations down the road. The same for asthma and other kinds of conditions. There are other times when it's going to cost more to do it right, but doing it right the first time -- that is every time -- means that fewer resources will be wasted in the long run.

ANNOUNCER: To benefit from quality care and to reward its delivery requires information about how doctors and hospitals perform. This information can drive changes in how insurance companies pay for care; choices patients make about where they go for treatment; and it can encourage doctors, hospitals and nursing homes to do a better job. Making this information available is often called health care “transparency.”

CAROLYN CLANCY, MD: Transparency has a number of different dimensions that I think are very important. One is it gives individuals good information about who is doing a better job. Probably more importantly, it gives health care professionals and organizations information about where they need to improve.

ANNOUNCER: Insurers are also using information on how doctors and hospitals perform to encourage patients to use providers who have better results.

REED TUCKSON, MD: So we're seeing, for example, new health benefit designs, new insurance products that provide financial incentive -- if you, in fact, choose the best performers. We're also seeing some new benefit package designs that provide financial penalties if you go to those institutions or to physicians who don't perform as well.

ANNOUNCER: Experts say improvements in quality in health care will also come when health care systems more fully embrace electronic medical records. Efforts to improve the quality and value of health care come from many sectors. The federal government via Medicare. The states. Employers and insurance companies. Increasingly, experts say patients must play a mayor role, too.

CAROLYN CLANCY, MD: Consumers have a very important role. A very famous health care researcher once said that the most underused resource in health care is the American consumer.

REED TUCKSON, MD: But, at the end of the day, you are sitting at your kitchen table on Sunday night and you've got to make a choice. I need to have a shoulder surgery done. Where do I go to get that care? How much money is it going to cost me and my family and how do I plan for the economics of that? And what control do I have over that expenditure? And so I'm going to look at the quality of care that's delivered, I'm going to look at the rates of complications, I'm going to look at the negotiated rate for in-network or out-of-network benefits. I'm going to look at a variety of things and, ultimately, as a health care consumer, I'm going to demand the same level of information and certainty -- of predictive certainty -- as I am expecting when I go to the store to buy a refrigerator or a stove.

ANNOUNCER: Experts agree Americans face many challenges in improving the quality and value of their health care. There are many solutions, and these include: expanding the use of electronic records, making available information about how well doctors and other health care providers deliver care, and changing how insurance companies, employers, and individuals pay for care.