Although the US health care system is often touted as one of the best
in the world, disparities exist in quality of care received by different populations,
in different regions, and across different institutions and clinicians. Initiatives
to provide access to health insurance have been a major policy tool to ensure
that Americans receive high-quality health care. However, availability of
insurance coverage does not automatically lead to high-quality care. This
article explores points of vulnerability in the US health care system at which
the potential to achieve high-quality care can be lost: (1) access to insurance
coverage; (2) enrollment in available insurance plans; (3) access to covered
services, clinicians, and health care institutions; (4) choice of plans, clinicians,
and health care institutions; (5) access to a consistent source of primary
care; (6) access to referral services; and (7) delivery of high-quality health
care services. Ensuring high-quality health care requires that each of these
"voltage drops" be recognized and addressed.
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