Cures for an Ailing System

Why do such disparities persist? Minority Americans are more likely to fall through the cracks of complex systems of care. Too often they lack insurance coverage, live in poor communities, experience language barriers and face subconscious biases of health professionals—factors that contribute to unacceptable disparities in care.

What should be done to eliminate these inequities? First, understand the specific barriers to high-quality care. Confronted with breast-cancer disparities in Chicago, local health-care and community leaders are improving access to mammograms and developing systems to ensure all women receive effective treatments without delay. Leaders in every community can do likewise—root out reasons that disparities persist for major illnesses and develop effective partnerships to eliminate them.
—John Z. Ayanian, M.D., M.P.P. Professor of Medicine and Health Care Policy at Harvard Medical School and a doctor at Brigham and Women's Hospital in Boston

Fix the Medicare Drug Benefit
Before launching any bold new initiatives, let's plug the leaks in the Medicare drug-benefit law. High drug costs can force elderly and disabled people to go hungry, to skip and split pills, and to suffer costly hospitalizations. In response, Congress passed legislation in 2003 giving Medicare beneficiaries insurance for prescription drugs. The drug benefit is controversial because beneficiaries have to pay high out-of-pocket expenses and choose from hundreds of private drug plans, each covering different drugs. While the program has helped many afford their medications, it won't achieve its original goals unless the new Congress and administration fix a few glaring defects.

First, plug the "doughnut hole." That is the gap in drug coverage between $2,250 and $5,100 in annual out-of-pocket costs that was created as a result of political compromise. Such coverage gaps are almost as hazardous as no coverage at all, especially for the several million people with costly illnesses who have fallen into the doughnut hole this year. The estimated $5 billion annual cost of eliminating this gap is only 1.3 percent of overall Medicare expenditures. This additional expense would improve health and might actually reduce overall expenses by lowering hospitalization costs.

Second, automatically enroll the 3 million to 4 million near-poor individuals who are already eligible for very low-cost drug coverage, but didn't sign up. The administration hasn't promoted the best coverage to this vulnerable group. Reaching them is as easy as looking up their tax and Social Security information.
—Stephen B. Soumerai, SC.D. Professor of Ambulatory Care and Prevention at Harvard Medical School

Use Quality-of-Care Report Cards
If Zagat's can rate Chinese restaurants and Greek tavernas, and Consumer Reports can rate skateboards and digital cameras, why can't we rate doctors? The answer is that we can. And, increasingly, we are doing so. Scores of Internet databases now provide more information than anyone can readily process on the quality of care provided by U.S. hospitals and health plans—and, sometimes, even by individual doctors.