The Commonwealth Fund, a private foundation working toward a high performance health system, released the results of their National Scorecard on U.S. Health System Performance, 2008. The scorecard indicates that U.S. health care continues to fall short of U.S. and international performance benchmarks, with a score of 65 out of a possible 100.
The scorecard measured 37 core indicators across five dimensions of health system performance - healthy lives, quality, access, efficiency, and equity. Although the scorecard indicates improvement in some areas (35% of the indicators, compared to the 2006 scorecard), there was a decline of 41% in other areas, and the rest exhibited no change.
U.S. Care and Healthy Lives
The first dimension measured by the scorecard - healthy lives - scored only a 72, which is a drop from 75 two years earlier. One of the categories in this dimension is preventable mortality - those deaths that might have been prevented with "timely and effective care." In this category, the U.S. fell to last place among 19 industrialized countries.
Another category in the healthy lives dimension is activity limitations. In the U.S., 18% of working-age adults (more than one in six) cite health problems as the reason they cannot work or carry out everyday activities, which is up 15% from the 2004 rate.
Quality of U.S. Health Care
The U.S. scored a 71 for quality of care, compared to 72 in 2006. The quality dimension covers such categories as effective care, timely care, and coordinated care. Although the scorecard shows some improvements in quality - for example, control of diabetes and high blood pressure have improved markedly - there were substantial differences between the top and bottom performers.
For instance, in 2006 patients hospitalized for heart failure were more likely to receive discharge instructions than in 2004, but "rates varied widely between top and bottom hospital groups." In addition, in 2007 less than half of U.S. adults were able to get a rapid appointment with a doctor when they were sick, and one-third of adults reported mistakes in their care.
Access to Health Care in the U.S.
The U.S. scored only a 58 in the area of health care access, much of which is affected by whether a person has medical insurance and, if so, the type of insurance. For instance, in 2007, 75 million adults (42%) were either uninsured or underinsured, up from 61 million in 2003.
In addition, 37% of adults in 2007 went without needed care because of costs, and 41% had medical debt or problems paying medical bills, compared to 34% in 2005, often resulting in medical bankruptcy.
Efficiency of the U.S. Health System
The U.S received its lowest score - 53 - in the area of efficiency. Care was often inappropriate, wasteful, or fragmented; quality and costs varied widely; administrative costs were exceedingly high; and there was a high rate of avoidable hospitalizations.
For example, U.S. patients were three to four times more likely than patients in other countries to have duplicate tests or to have medical tests or records unavailable at the time of their appointments. In addition, health insurance administrative costs ran 30-70% higher than in countries with mixed private/public insurance systems.
Equity in the U.S. Health System
The final dimension measured by the scorecard is equity, which scored a 71. Although still very low, this is up slightly from two years earlier. The problem is that certain groups were less likely to receive preventative care or have a source for primary care.
"Compared with their white, higher-income, or insured counterparts, minorities, low-income, or uninsured adults and children were generally more likely to wait when sick, to encounter delays and poorly coordinated care, and to have untreated dental caries, uncontrolled chronic disease, avoidable hospitalization, and worse outcomes."
Closing the Gap in Health Care
Overall, the Commonwealth Fund scorecard finds that the U.S. is losing ground in providing access to care. However, if these performance gaps could be closed, over 100,000 premature deaths could be prevented each year, and 37 million more adults would have access to a primary care provider. Addressing these issues could lead to both better care and significant savings for millions.
R.H. Sheldon - A number of years ago, long before I moved to the Northwest, I hitchhiked with a friend across Washington state to northern Idaho. We got ...
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