Study: Quality of Health Care Down

June 25 -- — Americans are getting only about half of the proper care they should be getting, regardless of their insurance coverage, according to one of the largest and most comprehensive studies done on the quality of American health.

The study, conducted by RAND Health and published in the New England Journal of Medicine, surveyed nearly 7,000 adults in 12 metropolitan areas of the United States and then reviewed their medical files.

"Most of us take health care for granted," said lead author Elizabeth McGlynn, and associate director of RAND Health. "This study shows we can't. There is a tremendous gap between what we [know] works and what patients are actually getting. Virtually everyone in this country is at risk for poor care."

And the services studied, she said, are necessities not luxuries.

"These are bread and butter," McGlynn said. "These are the basics of good medical care. It isn't care at the cutting edge. It isn't boutique care."

The quality of care varied considerably according to the medical condition, ranging from 79 percent of recommended care for cataracts among older to people to 11 percent of recommended care for people with alcohol dependence.

In other examples:

Researchers found that 55 percent of heart attack patients did not get common medications that could reduce their risk of dying. More than 75 percent of diabetics were not given semi-annual blood tests by their doctors that could help prevent kidney failure and blindness. About 46 percent of patients put on antidepressants never got any follow-up from their doctor to see if the drugs were effective or had any side effects.

So how, many Americans might ask, can a health-care system so expensive, so technologically advanced … be so deficient?

"It's designed to fail, not to work. It's too complicated," said Dr. Donald Berwick, a clinical professor of health-care policy at Harvard Medical School and president of the non-profit Institute for Health Care Improvement.