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February 27, 2008

Health Care as If Health Mattered

Author Affiliations

Author Affiliations: Dr Frieden is Health Commissioner for New York City; Dr Mostashari is Assistant Commissioner for the New York City Health Department's Primary Care Information Project.

JAMA. 2008;299(8):950-952. doi:10.1001/jama.299.8.950

There is consensus about the need for fundamental change in the US health care system and there has been attention to the important problems of inadequate access and increasing costs. But the most serious shortcoming—that the nation's health system is not designed to maximize health—has been overshadowed. Individuals in the United States receive only about half the recommended medical services.1 Only 43% of individuals with diagnosed diabetes,2 37% with hypertension,3 and 25% with hypercholesterolemia4 have adequate control of their disease; furthermore, less than 20% of smokers who try to quit receive assistance from their physicians, and only 2% are prescribed pharmacotherapy.5 Lack of effective primary health care is a public health problem that results in avoidable blindness, amputations, strokes, heart attacks, and premature death. Nearly 9 of 10 Americans with uncontrolled diabetes, hypertension, and hypercholesterolemia already have private or public health insurance.6