Quality is an 'afterthought' in the campaign for health care access, report finds

Associate professor of epidemiology Marcel Yotebieng co-authored a report that found between 5.7 and 8.4 million deaths occur each year from the poor quality of health care, rather than limited access to these services.

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October 10, 2018
Marcel Yotebieng, associate professor of epidemiology
Marcel Yotebieng, associate professor of epidemiology

Associate professor of epidemiology Marcel Yotebieng, MD, MPH, PhD, alongside 13 other experts in the field, co-authored a report released in August by the National Academy of Medicine.

The report, titled “Crossing the Global Quality Chasm: Improving health care worldwide,” describes a need for the public health community to shift their focus from strictly providing access to health services to instead providing high-quality, effective health care.

“I've been working in HIV for my entire professional life and I’m in public health because of access. I was a clinician and saw how difficult it was to have access to HIV care and treatment,” Yotebieng said. “But, now that we are on the positive trend of success in maximizing access to care, there is increasing evidence that access is not good enough.”

This research builds on the work of the 2001 Institute of Medicine report “Crossing the Quality Chasm.” The 2018 report uses six features of health care to characterize quality care, including safety, effectiveness, patient-centeredness, timeliness, efficiency and equity.

According to the 2018 report, access to low-quality care impacts factors other than physical health. Productivity is decreased between $1.4 and $1.6 trillion each year as a result of these deaths.

“So far, across the globe, our effort has been to provide access to people. It’s not enough to go to a hospital. We estimate 5 to 8 million people die because of poor quality every year and that's a low, low estimate,” Yotebieng said.

These deaths account for 10 to 15 percent of the total deaths in low- and middle-income countries.

Yotebieng said more measures are needed to identify and quantify high-quality health care services to improve the effectiveness of health care solutions and the elevate the impact care has on the population it is serving.

“We don't want to wait until death to measure that the quality wasn’t good,” Yotebieng said. “If something is important, we create words and measurements. We measure time in minutes and in seconds in a very precise manner. Why is it that when it comes to health care quality, we use very vague stuff to measure it? We focus on access and coverage, and quality is always an afterthought.”

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