Transforming Insurance Coverage Into Quality Health Care: Voltage Drops From Potential to Delivered Quality

Eisenberg, John M.; Power, Elaine J.

doi:10.1001/jama.284.16.2100

Cited by 158Healthcare Policy and ManagementHealthcare Systems and ReformsHealthcare Quality and Management

Transforming Insurance Coverage Into Quality Health Care: Voltage Drops From Potential to Delivered Quality

Eisenberg, John M., Power, Elaine J.·2000·JAMA

DOI 10.1001/jama.284.16.2100

Open this paper in CoChat — free account

Abstract

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. JAMA. 2000;284:2100-2107.

Integrity signals

Registry

Crossref · 10.1001/jama.284.16.2100

Cites

48 of 48 references verified0 citation errors · 0 not checkable

Statistics

Recomputing p-values needs the paper’s full text.

Claims the paper makes

This paper’s full text isn’t openly available, so its claims and self-check weren’t run. The registry and citation checks still apply.

Claims other papers make about this one

Each is checked against this paper’s own text: does it say what the citing paper says it does?

Receiving developmental support services is the last in a series of steps from screening to referral to evaluation to delivery, and each step is vulnerable to leakage ("voltage drops"), with disparities compounding throughout.
“Receiving these services is the last in a series of steps from screening to referral to evaluation to delivery. Each step is vulnerable to leakage (“voltage drops”), with disparities compounding throughout.10–12”
From Sustained Effectiveness of a 211 Call Center With Early Childhood Care Coordination (2025) · cites this paper as [10]

To Err Is Human
Institute of Medicine (2000) · National Academies Press eBooks · doi:10.17226/9728 · Cited by 14,174 · see citing works
The Effect of Race and Sex on Physicians' Recommendations for Cardiac Catheterization
Schulman, K. A., Berlin, J. A., Harless, W., Kerner, J. F., Sistrunk, S., Gersh, B. J., Dubé, R., Taleghani, C. K., Burke, J. E., Williams, S., et al. (1999) · New England Journal of Medicine · doi:10.1056/nejm199902253400806 · Cited by 1,934 · see citing works
Self-citation
Racial Differences in the Treatment of Early-Stage Lung Cancer
Bach, P. B., Cramer, L. D., Warren, J. L., & Begg, C. B. (1999) · New England Journal of Medicine · doi:10.1056/nejm199910143411606 · Cited by 991 · see citing works
Changing Physicians' Practices
Greco, P. J., & Eisenberg, J. M. (1993) · New England Journal of Medicine · doi:10.1056/nejm199310213291714 · Cited by 976 · see citing works
Self-citation
Improving the Outcomes of Coronary Artery Bypass Surgery in New York State
Hannan, E. L. (1994) · JAMA · doi:10.1001/jama.1994.03510340051033 · Cited by 757 · see citing works
Racial Variation in the Use of Coronary-Revascularization Procedures — Are the Differences Real? Do They Matter?
Peterson, E. D., Shaw, L. K., DeLong, E. R., Pryor, D. B., Califf, R. M., & Mark, D. B. (1997) · New England Journal of Medicine · doi:10.1056/nejm199702133360706 · Cited by 550 · see citing works
Effects of Medicaid Drug-Payment Limits on Admission to Hospitals and Nursing Homes
Soumerai, S. B., Ross‐Degnan, D., Avorn, J., McLaughlin, T. J., & Choodnovskiy, I. (1991) · New England Journal of Medicine · doi:10.1056/nejm199110103251505 · Cited by 506 · see citing works
The Unreliability of Individual Physician "Report Cards" for Assessing the Costs and Quality of Care of a Chronic Disease
Hofer, T. P. (1999) · JAMA · doi:10.1001/jama.281.22.2098 · Cited by 502 · see citing works
Use of medical care in the Rand Health Insurance Experiment. Diagnosis- and service-specific analyses in a randomized controlled trial.
Lohr, K. N., Brook, R. H., KAMBERG, C. J., Goldberg, G. A., Leibowitz, A. A., KEESEY, J. W., Reboussin, D. M., & Newhouse, J. P. (1986) · PubMed · Cited by 341 · see citing works
Health Insurance and Mortality
Franks, P. J. (1993) · JAMA · doi:10.1001/jama.1993.03510060083037 · Cited by 331 · see citing works
Resolving the Gatekeeper Conundrum
Grumbach, K., Selby, J. V., Damberg, C. L., Bindman, A. B., Quesenberry, C. P., Truman, A. F., & Uratsu, C. S. (1999) · JAMA · doi:10.1001/jama.282.3.261 · Cited by 288 · see citing works
Inappropriate Use of Hospitals in a Randomized Trial of Health Insurance Plans
Siu, A. L., Sonnenberg, F. A., Manning, W. G., Goldberg, G. A., Bloomfield, E. S., Newhouse, J. P., & Brook, R. H. (1986) · New England Journal of Medicine · doi:10.1056/nejm198611133152005 · Cited by 286 · see citing works
Primary care and receipt of preventive services
Bindman, A. B., Grumbach, K., Osmond, D. H., VRANIZAN, K. M., & Stewart, A. L. (1996) · Journal of General Internal Medicine · doi:10.1007/bf02598266 · Cited by 280 · see citing works
The Cost Of Health System Change: Public Discontent In Five Nations
Donelan, K., Blendon, R. J., Schoen, C., Davis, K. C., & Binns, K. (1999) · Health Affairs · doi:10.1377/hlthaff.18.3.206 · Cited by 250 · see citing works
Socioeconomic Status and Risk for Substandard Medical Care
Burstin, H. R. (1992) · JAMA · doi:10.1001/jama.1992.03490170055025 · Cited by 242 · see citing works
More Offers, Fewer Takers for Employment-Based Health Insurance: 1987 and 1996
Cooper, P. F., & Schone, B. S. (1997) · Health Affairs · doi:10.1377/hlthaff.16.6.142 · Cited by 237 · see citing works
The timing of preventive services for women and children: the effect of having a usual source of care.
Ettner, S. L. (1996) · American Journal of Public Health · doi:10.2105/ajph.86.12.1748 · Cited by 180 · see citing works
Acutely injured patients with trauma in Massachusetts: differences in care and mortality, by insurance status.
Haas, J. S., & Goldman, L. (1994) · American Journal of Public Health · doi:10.2105/ajph.84.10.1605 · Cited by 172 · see citing works
A Critical Analysis of Studies of State Drug Reimbursement Policies: Research in Need of Discipline
Soumerai, S. B., Ross‐Degnan, D., Fortess, E. E., & Abelson, J. (1993) · Milbank Quarterly · doi:10.2307/3350399 · Cited by 169 · see citing works
Prescription Drug Coverage, Utilization, And Spending Among Medicare Beneficiaries
Davis, M. H., Poisal, J. A., Chulis, G. S., Ƶarabozo, C., & Cooper, B. (1999) · Health Affairs · doi:10.1377/hlthaff.18.1.231 · Cited by 146 · see citing works
Choice of a Personal Physician and Patient Satisfaction in a Health Maintenance Organization
Schmittdiel, J. A. (1997) · JAMA · doi:10.1001/jama.1997.03550190060045 · Cited by 143 · see citing works
The Commonwealth Fund Survey of the Health of Adolescent Girls
Schoen, C., Abrams, M. K., & Davis, K. C. (1997) · Cited by 130 · see citing works
Methods to Encourage the Use of Antenatal Corticosteroid Therapy for Fetal Maturation: A Randomized Controlled Trial
Leviton, L. C., Goldenberg, R. L., Baker, C. S., Schwartz, R. M., Freda, M. C., Fish, L. J., Cliver, S. P., Rouse, D. J., Chazotte, C., Merkatz, I. R., et al. (1999) · JAMA · doi:10.1001/jama.281.1.46 · Cited by 128 · see citing works
Access to Hypertensive Care
Moy, E. M. (1995) · Archives of Internal Medicine · doi:10.1001/archinte.1995.00430140063005 · Cited by 127 · see citing works
Out-of-pocket health spending by poor and near-poor elderly Medicare beneficiaries.
Gross, D. J., Alecxih, L. M. B., Gibson, M. J., et al. (1999) · PubMed · Cited by 123 · see citing works
Effects of Cost Sharing on Seeking Care for Serious and Minor Symptoms
Shapiro, M. F., WARE, J. E., & SHERBOURNE, C. D. (1986) · Annals of Internal Medicine · doi:10.7326/0003-4819-104-2-246 · Cited by 115 · see citing works
Medicaid's Problem Children: Eligible But Not Enrolled
Selden, T. M., Banthin, J. S., & Cohen, J. W. (1998) · Health Affairs · doi:10.1377/hlthaff.17.3.192 · Cited by 114 · see citing works
Variation in staging and treatment of local and regional breast cancer in the elderly
Hillner, B. E., Penberthy, L., Desch, C. E., et al. (1996) · Breast Cancer Research and Treatment · doi:10.1007/bf01806004 · Cited by 110 · see citing works
Adolescent girls’ and boys’ preferences for provider gender and confidentiality in their health care
Kapphahn, C. J., Wilson, K. M., & Klein, J. D. (1999) · Journal of Adolescent Health · doi:10.1016/s1054-139x(99)00050-6 · Cited by 109 · see citing works
Understanding the Quality Challenge for Health Consumers: The Kaiser/AHCPR Survey
Robinson, S., & Brodie, M. (1997) · The Joint Commission Journal on Quality Improvement · doi:10.1016/s1070-3241(16)30313-3 · Cited by 108 · see citing works
Foreword
Crofton, C., Lubalin, J. S., & Darby, C. (1999) · Medical Care · doi:10.1097/00005650-199903001-00001 · Cited by 104 · see citing works
Changes in access to care, 1977-1996: the role of health insurance.
Zuvekas, S. H., & Weinick, R. M. (1999) · PubMed · Cited by 95 · see citing works
Ten Lessons for Evidence-Based Technology Assessment
Eisenberg, J. M. (1999) · JAMA · doi:10.1001/jama.282.19.1865 · Cited by 84 · see citing works
Self-citation
The direct and indirect effects of cost-sharing on the use of preventive services.
Solanki, G. C., Schauffler, H. H., & Miller, L. (2000) · PubMed · Cited by 82 · see citing works
The effect of change of health insurance on access to care.
Burstin, H. R., Swartz, K., O’Neil, A. C., Orav, E. J., & Brennan, T. A. (1998) · PubMed · Cited by 73 · see citing works
Effects of health care cost-containment programs on patterns of care and readmissions among children and adolescents.
Wickizer, T. M., Lessler, D. S., & Boyd-Wickizer, J. (1999) · American Journal of Public Health · doi:10.2105/ajph.89.9.1353 · Cited by 62 · see citing works
Why Are Workers Uninsured? Employer-Sponsored Health Insurance In 1997
Thorpe, K. E., & Florence, C. (1999) · Health Affairs · doi:10.1377/hlthaff.18.2.213 · Cited by 48 · see citing works
Waiting In The Wings: Eligibility And Enrollment In The State Children's Health Insurance Program
Selden, T. M., Banthin, J. S., & Cohen, J. W. (1999) · Health Affairs · doi:10.1377/hlthaff.18.2.126 · Cited by 47 · see citing works
Technology Coverage Decisions by Health Care Plans and Considerations by Medical Directors
Steiner, C., Powe, N. R., Anderson, G. F., et al. (1997) · Medical Care · doi:10.1097/00005650-199705000-00005 · Cited by 43 · see citing works
Information sources and barriers to cancer treatment by racial/ethnic minority status of patients.
Guidry, J. J., Aday, L. A., Zhang, D., & Winn, R. J. (1998) · PubMed · doi:10.1080/08858199809528511 · Cited by 39 · see citing works
Children’s Health Insurance Coverage and Family Structure, 1977-1996
Weinick, R. M., & Monheit, A. C. (1999) · Medical Care Research and Review · doi:10.1177/107755879905600104 · Cited by 31 · see citing works
Patient satisfaction and visiting the doctor: A self-regulating system
Mirowsky, J., & Ross, C. E. (1983) · Social Science & Medicine · doi:10.1016/0277-9536(83)90195-8 · Cited by 24 · see citing works
The Pursuit Of Quality By Business Coalitions: A National Survey
Fraser, I., McNamara, P., Lehman, G. O., et al. (1999) · Health Affairs · doi:10.1377/hlthaff.18.6.158 · Cited by 20 · see citing works
Does Health Insurance Make a Difference?
Dougherty, D. M. (1992) · JAMA · doi:10.1001/jama.1992.03490150031005 · Cited by 19 · see citing works
Paying More Twice: When Employers Subsidize Higher-Cost Health Plans
Hunt, K. A., Singer, S. J., Gabel, J. R., et al. (1997) · Health Affairs · doi:10.1377/hlthaff.16.6.150 · Cited by 18 · see citing works
Health insurance choices in two-worker households: determinants of double coverage.
Monheit, A. C., Schone, B. S., & Taylor, A. K. (1999) · PubMed · Cited by 17 · see citing works
Who declines employer-sponsored health insurance and is uninsured?
Pj, C., Schaefer, E., & Hogan, C. J. (1999) · PubMed · Cited by 11 · see citing works
How widespread is managed competition?
Sh, L., & Ms, M. (1998) · PubMed · Cited by 3 · see citing works

Flagged first, then by citations

Sorted by citations

Improving the Quality of Health Care in the United Kingdom and the United States: A Framework for Change
Ferlie, E. B., & Shortell, S. M. (2001) · The Milbank Quarterly · doi:10.1111/1468-0009.00206 · Cited by 1,335 · see citing works
The Oregon Experiment — Effects of Medicaid on Clinical Outcomes
Baicker, K., Taubman, S. L., Allen, H. L., Bernstein, M., Gruber, J. H., Newhouse, J. P., Schneider, E. C., Wright, B. J., Zaslavsky, A. M., & Finkelstein, A. N. (2013) · New England Journal of Medicine · doi:10.1056/nejmsa1212321 · Cited by 1,150 · see citing works
Re-engineering systems for the treatment of depression in primary care: cluster randomised controlled trial
Dietrich, A. J., Oxman, T. E., Williams, J. W., Schulberg, H. C., Bruce, M. L., Lee, P. W., Barry, S., Raue, P. J., Lefever, J. J., Heo, M., et al. (2004) · BMJ · doi:10.1136/bmj.38219.481250.55 · Cited by 308 · see citing works
Prevalence, Treatment, and Control of Depressive Symptoms in the United States: Results from the National Health and Nutrition Examination Survey (NHANES), 2005-2008
Shim, R. S., Baltrus, P., Ye, J., & Rust, G. (2011) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2011.01.100121 · Cited by 267 · see citing works
Disparities in surgical access: a systematic literature review, conceptual model, and evidence map
de Jager, E., Levine, A. A., Udyavar, R. N., Burstin, H. R., Bhulani, N., Hoyt, D. B., Ko, C. Y., Weissman, J. S., Britt, L. D., Haider, A. H., et al. (2019) · Journal of the American College of Surgeons · doi:10.1016/j.jamcollsurg.2018.12.028 · Cited by 178 · see citing works
Unmet Health Care Need in US Adolescents and Adult Health Outcomes
Hargreaves, D. S., Elliott, M. N., Viner, R. M., Richmond, T. K., & Schuster, M. A. (2015) · Pediatrics · doi:10.1542/peds.2015-0237 · Cited by 111 · see citing works
A systematic review of integrated care interventions addressing perinatal depression care in ambulatory obstetric care settings
MOORE SIMAS, T. A., FLYNN, M. P., KROLL-DESROSIERS, A. R., CARVALHO, S. M., LEVIN, L. L., BIEBEL, K., & BYATT, N. (2018) · Clinical Obstetrics & Gynecology · doi:10.1097/grf.0000000000000360 · Cited by 63 · see citing works
Access and quality in child health services: voltage drops
Chung, P. J., & Schuster, M. A. (2004) · Health Affairs · doi:10.1377/hlthaff.23.5.77 · Cited by 35 · see citing works
Quality health care for children and the Affordable Care Act: a voltage drop checklist
Cheng, T. L., Wise, P. H., & Halfon, N. (2014) · Pediatrics · doi:10.1542/peds.2014-0881 · Cited by 17 · see citing works
Sustained Effectiveness of a 211 Call Center With Early Childhood Care Coordination
Nelson, B. B., Dudovitz, R. N., Romley, J. A., Thompson, L. R., Vangala, S., Gallegos, A., Gulsrud, A., Calderon, K., Porras-Javier, L., Herrera, P., et al. (2025) · Pediatrics · doi:10.1542/peds.2025-071644 · Cited by 4 · see citing works

Authors: Eisenberg, J. M., & Power, E. J.
Affiliations: Agency for Healthcare Research and Quality (US)
Venue: JAMA
Publisher: American Medical Association (AMA)
Published: 2000-10-25
Volume: 284
Issue: 16
Pages: 2100
ISSN: 0002-9955 (ISSN-L)
0098-7484
DOI: 10.1001/jama.284.16.2100
OpenAlex: W2048498021
Cited by: 158
References: 48
Citations by year: 2026: 3 · 2025: 1 · 2024: 4 · 2023: 11 · 2022: 9 · 2021: 9 · 2020: 9 · 2019: 7 · 2018: 4 · 2017: 4 · 2016: 5 · 2015: 10 · 2014: 11 · 2013: 7 · 2012: 8
FWCI: 10.34
Type: journal article
Language: en
Open access: closed
Locations: JAMA (publishedVersion)
PubMed (publishedVersion)
DigitalGeorgetown (Georgetown University Library) (submittedVersion)
Topics: Social Sciences › Economics, Econometrics and Finance › Economics and Econometrics › Healthcare Policy and Management
Social Sciences › Economics, Econometrics and Finance › Finance › Healthcare Systems and Reforms
Health Sciences › Health Professions › Health Information Management › Healthcare Quality and Management
Keywords: health insurance coverage, quality of care, health care disparities, insurance enrollment, health care access, primary care access, referral services, health care delivery, health policy
MeSH terms: Delivery of Health Care, Health Services Accessibility, Insurance, Health, Primary Health Care, Quality of Health Care, Referral and Consultation, United States, Insurance Coverage

About these checks

Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.

Statistics and arithmetic are recomputed, not judged.

Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.

What counts as a claim ›How we measure confidence ›How we check this ›

Are you an author, or do you see a problem with this page? Request a review

Transforming Insurance Coverage Into Quality Health Care: Voltage Drops From Potential to Delivered Quality

Abstract

Integrity signals

Claims the paper makes

Claims other papers make about this one

Cites

Cited by

Related

Record

About these checks