Transforming insurance coverage into quality health care - Voltage drops from potential to delivered quality

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