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U.S. Health System Performance Falls Short Of Attainable Goals

Why doesn’t the US have the best health care system in the world?  That’s the question The Commonwealth Fund Commission on a High Performance Health System asks in its report, “Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2011.” Excerpt:

“U.S. health system performance continues to fall far short of what is attainable, especially given the enormity of public and private resources devoted nationally to health. Across 42 performance indicators, the U.S. achieves a total score of 64 out of a possible 100, when comparing national rates with domestic and international benchmarks. Overall, the U.S. failed to improve relative to these benchmarks, which in many cases rose. Costs were up sharply, access to care deteriorated, health system efficiency remained low, disparities persisted, and health outcomes failed to keep pace with benchmarks. The Affordable Care Act targets many of the gaps identified by the Scorecard.”

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Just a couple of indicators from the report:

• Infant mortality. While infant mortality modestly improved from 2002 to 2007 (from 7.0 to 6.8 deaths per 1,000 live births), the U.S. rate is still more than 35 percent higher than the rates achieved by the best individual states. In fact, rates in the best states are twice as high as those achieved in certain industrialized countries. High infant mortality is related to high rates of preterm births, which in turn are related to long-term maternal health as well as quality of pregnancy care.

• Safe care. In a sign that safety concerns extend beyond the hospital, in 2007 one-quarter of elderly Medicare beneficiaries were prescribed a drug that is potentially inappropriate for older people. Rates were twice as high in some regions of the country as in others (36% vs. 18%). Wider use of electronic systems that alert clinicians of such risks may help improve safety in the near future.

• Patient-centered, timely, coordinated care. In 2008, only 43 percent of U.S. adults with health problems were able to rapidly secure an appointment with a physician when they were sick–about half the rate in the best country. U.S. adults also were among the most likely of those in eight countries surveyed to report difficulty obtaining health care after regular office hours without going to the emergency department. And 19 percent of U.S. patients reported undergoing duplicate tests–almost five times the rate in the benchmark country.

• Disparities. Minorities and low-income or uninsured adults and children were generally more likely than their white, higher-income, or insured counterparts to wait to see a doctor when sick, to encounter delays and experience poorly coordinated care, and to have untreated dental caries, uncontrolled chronic disease, avoidable hospitalizations, and worse outcomes. And they were less likely to receive preventive care or have an accessible source of primary care.

We consistently urge journalists to tell these stories and pursue these angles more often than they spend time reporting on new treatments, tests, products and procedures. Because we believe the public discourse too often focuses on the “more is better, newer is better” myth of health care, missing the facts on what we’re not getting for our world-leading percentage of the Gross Domestic Product devoted to health care spending.

*This blog post was originally published at Gary Schwitzer's HealthNewsReview Blog*


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