WASHINGTON -- Routine failure to provide needed health care in the United States came with the price tag of $1.8 billion in additional medical costs and up to 79,000 avoidable deaths, according to a new study.

In its annual report, the private National Committee for Quality Assurance said there was some improvement last year in the care offered by the nation's managed care organizations.

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The performance improvements recorded last year among the 563 health plans that reported their results -- covering about 69 million people -- were among the largest ever.

"The data we have tell a great story: Health care quality for some is improving consistently and dramatically," said NCQA President Margaret O'Kane. "But we only have data for accountable health plans. Why don't we have performance data for the other 75 percent of the U.S. health care system? All types of health plans, hospitals and doctors should report on their performance. How else can we make informed choices?"

But the report found wide variations in the treatment of conditions including high blood pressure and diabetes, as well as in breast cancer screening and flu shots for adults. And no gains were made in the area of treating mental illness.

The findings suggest that the system is deeply polarized, delivering excellent care to some people and generally poor care to many others.

"Purchasers see these quality gaps at the same time they are facing the fourth straight year of double-digit price increases," said Peter Lee, president and CEO of Pacific Business Group on Health. "This report underscores that all too often, we are not getting good value for that money."

The report includes suggestions on improving quality, including a pay-for-performance plans for doctors so they would have the incentive to apply best practice care. Currently, doctors are generally compensated based on the amount of care they provide -- not the quality of care.

Estimated Deaths Attributable to Failure to Deliver Recommended Care
Selected Measures/Conditions (U.S. Population)
Measure	Avoidable Deaths (range)
Controlling High Blood Pressure	15,000 - 26,000
Cholesterol Control	6,900 - 17,000
Diabetes Care–HbA1c Control	4,300 - 9,600
Smoking Cessation (with medication)	5,400 - 8,100
Flu Shots	3,500 - 7,300
Colorectal Cancer Screening	4,200 - 6,300
Beta-Blocker Treatment	900 - 1,900
Prenatal Care	600 - 1,400
Breast Cancer Screening	600 - 1,000
Cervical Cancer Screening	600 - 800
Total:	42,000 - 79,400
Source: National Committee for Quality Assurance, 2004 Annual Report