Improving quality is a challenge that continues to drive conversations and discussions about healthcare systems. Providing high-quality can be difficult. Healthcare is complicated, it's rapidly changing, we keep getting new therapies, and new data, and other new opportunities. Healthcare often involves multiple people who have to come together and work well together in order to provide care. Some things in healthcare have to be done quickly. It's a complex environment and getting it right can be a challenge. Many studies over time have looked at the quality of care provided in different healthcare systems, and often enough, they turn up opportunities to do better. These can come in a variety of forms. One of the frameworks used here notes three types of challenges, underuse is one, where we find services that we would like everybody to be doing or getting, but we don't get enough of. For example, one can sometimes find cases where relatively but beneficial preventive care was not used as widely as it could be or perhaps should be. Second, there could also be overuse. There are services we think have some value for some patients at some times, but we may find ourselves in situations where they're overused, where they don't create value, or even sometimes where they can lead to problems. Doing MRI scans for too many patients with low back pain is one example that's gotten some attention here. Then the third category in the framework is misuse, making errors, using a treatment when it should not have been used, giving a patient a medication that interacted badly with another medicine the patient was taking, leading to problems maybe because someone wasn't keeping track well enough of all the medications that a patient was taking. Of course, healthcare providers and the healthcare system generally, has many people in it that are highly motivated to improve quality. The fact that studies can find underuse, or overuse, or misuse suggests challenges, but then also suggests opportunities for improvement. This generates pressure of course on the healthcare system. Some of this lands on the intermediaries and the governments who want to monitor quality, who want to be thinking about their responsibility to their members or their population to help improve quality, and to help steer the healthcare system in that direction. Of course, providers are also right in the middle of this. Providers want to make sure they're providing high-quality healthcare, doing everything they can to help their patients. This has led to lots of efforts to monitor care, create data, create measurement tools, reporting tools, design better systems, disseminate new information, and so on, so that we can try to improve quality. Let's also take note of the challenge of providing access to care and access to coverage. We can have a variety of issues here for a variety of reasons, and the specifics can vary from one country to another. The US particularly, has had a history of not being able to get healthcare, health insurance for its entire population, leaving some people without insurance, which can make it difficult for them to get access to the care that they need. There can be other access challenges too. Some come from socioeconomic disparities in access to care or use of care. People with higher or lower incomes can have different abilities to access care, it might depend on the healthcare system they're working in. People with different levels of education may find it differently accessible. There can be cultural issues that can arise, there can be language barriers that come up, sometimes access issues reflect a lack of providers. We may not have all the physicians or all the hospitals in some areas that would make it easy for the population to get services, and some people may have to travel along ways to find the provider they need, that may make access difficult. Access challenges also suggest opportunities for improvement. Participants in the healthcare system are often interested in identifying approaches, and tools, and other things that can help with the access problems that we face.
