How has the quality of the US healthcare system changed over time?


How can we know if the performance of the health system overall in the U.S. is good and if it is getting better or worse over time?  This collection of charts and a related brief explore trends in quality metrics in the United States over time.

Mortality rates have fallen steadily in the U.S. over the past 30 years


Gauging the quality of healthcare systems is often difficult and restricted by the availability of data. One method for measuring quality is to look at mortality rates. Mortality rates can be influenced by a myriad of factors, one of which is the quality of the healthcare system for diseases where mortality is amenable to health care. The mortality rate (number of deaths per 100,000 people) in the U.S. has fallen about 30 percent between 1980 and 2013.

Infant mortality in the United States has improved by about 13% from 2000 to 2013


From 2000 to 2013, the infant mortality rate in the U.S. improved by about 13 percent.

Deaths amenable to healthcare in the U.S. have been steadily declining


Researchers have looked at mortality that results from medical conditions for which there are recognized healthcare interventions that would be expected to prevent death. While the healthcare system might not be expected to prevent death in all of these instances, differences in mortality for these conditions provides information about how effectively healthcare is being delivered. From 2002-2010, the mortality rate for deaths amenable to healthcare in the US has steadily declined.

Potential Years of Life Lost have fallen about 38% since 1980


Potential Years of Life Lost (PYLL) is a measure of premature death. The U.S. has made progress in reducing PYLL’s over the last thirty years.

Disease burden has declined from 1990 – 2013


Disability adjusted life years (DALYs) are a measure of disease burden and the rate per 100,000 shows the total number of years lost to disability and premature death. The disease burden has declined about 15 percent from 1990 – 2013.

The percentage of adults reporting poor general health has increased across males and females, whites and Hispanics


The percentage of people reporting poor general health has increased across males, females, whites, and Hispanics. Women and Non-Hispanic blacks are more likely to report being in poor health than other groups. While all groups other than Non-Hispanic blacks have increased the reporting of poor general health by about 32 percent, Non-Hispanic blacks have continuously had the largest percentage of people reporting poorer health than any other group.

The percentage of adults reporting poor physical or mental health in the past month has worsened over time


The percentage of people reporting poor physical and mental health has worsened over time.

The average number of self-reported healthy days per month has decreased slightly over time


Healthy days is a measure of Health Related Quality of Life that represents the average number of days in the past 30 that respondents’ mental and physical health is reported as good. Since 1996, the average number of general, mental, and physical “healthy days” has declined.

Screening and preventive care among adults 50 and older has remained fairly static


Screening and prevention can improve health outcomes when a disease is caught in the early stages. Screening and prevention among adults 50 and older has remained fairly static from 2006 to 2012.

The percent of children receiving recommended doses of vaccines has fluctuated slightly in recent years


The Children’s Health Insurance Program (CHIP) was established in 1997 and made health insurance available to children in near-poor families who are ineligible for Medicaid. One of the CHIP mandates is to cover the cost and administration of childhood vaccines. This program has helped ensure children continue to receive the recommended vaccinations, but prior to the passage of CHIP there was a significant increase in the percentage of children receiving vaccinations. The portion of children receiving recommended doses of vaccines for Diphtheria, Tetanus, Pertussis, Measles, and Hepatitis B increased through the late ’90s and has been relatively stable since then.

The teen pregnancy rate has declined 63% in the past quarter century


The birth rate for teenagers in the U.S. has declined but there are large differences among states. Teen birth rates in the Northeast have generally been the lowest, while birth rates in the South and Southeast have generally been the highest across the U.S.

The prevalence of overweight adults in the U.S. is beginning to decline after increasing for some time


The percentage of people with an overweight, obese, or extremely obese body mass index (BMI) for people in the United States has increased by 22 percent from the 1988-1994 time period to 2011-2012.

Medicare hospital admissions for ambulatory care-sensitive conditions has decreased about 27%


While not all hospital admissions for ambulatory care sensitive conditions are preventable, access to appropriate primary health care can prevent the onset of these types of illnesses and conditions. Proper management of diseases like asthma, chronic obstructive pulmonary disease, diabetes, and hypertension can help reduce hospital admissions. Medicare hospital admissions for ambulatory care-sensitive conditions have decreased from 2007 to 2013.

Patients receiving recommended care has improved slightly from 2005-2010


The proportion of patients receiving recommended care increased from 66 percent in 2005 to 70 percent in 2010, though most of that improvement occurred between 2005 and 2007 (not shown in chart).

Staff response to hospitalized patients has improved


Patients’ perspectives on hospital care provide another method for measuring the quality of the health care system. Staff response to hospitalized patients has improved nearly 10 percent from 2007 – 2013.

More women are receiving biopsy at the time of mastectomy or lumpectomy


There are well established evidence-based courses of care for various diseases, such as breast cancer. In 2011, 94.3% of women received axillary node dissection or sentinel lymph node biopsy at the time of lumpectomy or mastectomy in order to ensure proper diagnosis and identify the possible spread of cancer to the lymph nodes.

More people are receiving evidence-based care for heart attack when they arrive at a hospital


Receiving evidence-based treatment upon presentation of a heart attack can minimize mortality. Between 2005 and 2013, hospital patients with a heart attack increasingly received fibrinolytic medication within 30 minutes of arrival.

More patients hospitalized for heart failure are given evidence-based prescriptions at discharge


Since 2005, an increasing percentage of patients who experienced heart failure and left ventricular systolic dysfunction have been discharged with a prescription for an angiotensin-converting enzyme (ACE) inhibitor or an angiotensin receptor blocker.

More hospitalized patients are receiving instructions for recovery at home


When patients are given instructions for recovery at home after hospitalization it can improve health outcomes. From 2007 to 2013, about 9 percent more patients are receiving instructions for recovery at home.

The number of Hospital Acquired Conditions has improved


Hospital acquired conditions (HACs) are infections or conditions that people get while they are in the hospital that could have reasonably been prevented through the application of evidence-based guidelines. Some of these conditions include adverse drug events, pressure ulcers, ventilator associated pneumonia, catheter-associated infections, and air embolisms. Between 2010 and 2015 there was a decline in all categories of HACs.

Medicare 30-day hospital readmission rates have declined


Hospital readmission within 30-days of being discharged from a hospital stay is not entirely preventable, but can be reduced for certain diagnoses and services. Improvement in this area is often linked to improved quality of care. Medicare 30-day hospital readmission rates have improved about 8 percent from 2007-2013.

Mortality rates within 30 days after hospital admission for heart attack and stroke have decreased


Mortality within 30 days of being discharged from a hospital stay is not entirely preventable, but can be reduced for certain diagnoses. Improvement in this area is often linked to improved quality of care. The 30-day mortality rates for heart attack (acute myocardial infarction) and ischemic strokes (caused by blood clots) improved slightly from 2009 to 2015.

Five-year survival for certain cancers are increasing


The five-year survival rates for breast cancer and colorectal cancer in the U.S. improved. While mortality rates are used to measure the outcomes for most diseases, the quality of cancer care is often assessed through five-year survival rates. The use of five-year survival rates versus mortality rates has been debated recently, though, as survival rates may be more heavily influenced by the time of diagnosis than the actual longevity of the patient.

The mortality rate for cancers has been declining


The mortality rate for all cancers (neoplasms) has fallen in the U.S. over the last 30 years. In the U.S., the age-adjusted cancer rate has fallen from about 242 deaths per 100,000 population in 1980 to about 199 per 100,000 in 2010.

Mortality rates for diseases of the circulatory system have fallen dramatically over the last 30 years


The U.S. has made dramatic progress in lowering mortality from diseases of the circulatory system. In the U.S., the mortality rate has fallen from 629 deaths per 100,000 population in 1980 to 253 in 2013.

The mortality rate for respiratory diseases has declined since 1998


Mortality rates for respiratory diseases have fallen over the past 10 years.

Mortality rates for endocrine, nutritional and metabolic diseases have fallen over the last 15 years


After rising significantly between 1985 and 1995, mortality rates for these diseases have fallen steadily between 1995 – 2013.