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Commonwealth Fund: U.S. Healthcare System Gets Low Scores in Patient Care, Access, Affordability

Despite areas of improvement, the U.S. healthcare system as a whole failed to improve when compared to best performers in the United States, and among other nations, according to the third national scorecard report from the Commonwealth Fund Commission (CFC). The U.S. healthcare system scored 64 out of 100 on key measures of performance, the CFC added.

The United States scored particularly low in access to care and affordability, as healthcare costs rose faster than family incomes. The report, Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, measures the U.S. healthcare system across 42 key indicators of healthcare quality, access, efficiency, equity, and healthy lives. The scorecard compares U.S. average performance to rates achieved by the top 10 percent of U.S. states, regions, health plans, hospitals or other providers or top-performing countries. The 2011 score of 64 was slightly below the overall score of 67 in the first national scorecard published in 2006, and the score of 65 in the second scorecard, in 2008.

Key findings from the study include the following:

  • Forty-four percent of adults report that they didnít have an accessible primary care provider in 2008, and only half of adults received all recommended preventive care. Thirty-two percent of children ages 10 to 17 were overweight or obese.
  • One-quarter of elderly Medicare beneficiaries were prescribed a potentially inappropriate drug.
  • The United States ranks last out of 16 countries when it comes to deaths that could have been prevented by timely and effective medical care. If the United States could do as well as the leading country, as many as 91,000 fewer people would die prematurely every year.

Some of the reasons for the United States' low scores are as follows:

  • By 2010, 81 million adults were either underinsured or uninsured at some point during the year - up from 61 million in 2003. For those with insurance, premiums rose far faster than incomes.
  • In 2003, 57 percent of Americans lived in a state where health insurance premiums averaged less than 15 percent of average (median) incomes. By 2009, only 4 percent of the population lived in such states.
  • By 2010, 40 percent of working-age adults had medical debt or faced problems paying medical bills up from 34 percent in 2005.

Duplicative services, high hospital readmissions, low use of EHRs, and high administrative costs contributed to the score of 53 in health system efficiency. Reducing health insurance administrative costs to the average level achieved in countries with mixed private-public insurance systems, like the United States, would save $55 billion a year.

But in care quality areas that have been the focus of public reporting or collaborative improvement initiatives the United States did well: In 2007 to 2008, 50 percent of adults with high blood pressure had it under control, compared with only 31 percent in 1999 to 2000. In addition, hospital quality indicators for treatment of heart attack, heart failure, pneumonia, and prevention of surgical complications, have improved substantially across the country since hospitals began publicly reporting their quality data through a federal website.

The authors note that the latest data in the scorecard primarily fell between 2007 and 2009, before enactment of the Affordable Care Act. They point out that provisions in the new law target areas for improvement where the United States falls short, particularly in access to care, affordability of care, and support for more patient-centered, coordinated care.

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Source: The Commonwealth Fund, October 18, 2011


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