Study: U.S. health costs rise,<br> access declines, outcomes lag

NEW YORK – A new national scorecard from The Commonwealth Fund shows the U.S. health care system has failed to improve overall in the last two years, access to care has declined significantly, and outcomes, quality and efficiency continue to fall far short of other nations’.
The report, from the fund’s Commission on a High Performance Health System, updates a previous scorecard issued in 2006. Titled “Why Not The Best?” it rates the U.S. health care system a 65 overall out of a possible 100 across 37 key indicators of health outcomes, quality, access, efficiency, and equity, down two points from the 2006 overall score.
In addition, the U.S. system was rated 58 out of 100 for access to care, down nine points from 2006, and 53 out of 100 for health care efficiency, in part because of lack of adoption of electronic health records among physicians.
While U.S. primary care doctors’ use of electronic medical records increased from 17 percent to 28 percent from 2001 to 2006, the fund said in a news release, the United States “lags far behind leading countries where 98 percent of doctors have electronic records, often with advanced system capacity to support doctors and patients.”
The report also shows the number of uninsured and underinsured continues to rise, with 42 percent of all working-age adults either uninsured or underinsured in 2007, up from 35 percent in 2003. Moreover, the United States “failed to keep up with improvements made in other countries,” the fund said, falling from 15th to last among 19 industrialized nations when it comes to premature deaths that could have been prevented by timely access to good care.
“The scorecard tells us that we are losing ground in crucial areas like access to health care,” said lead researcher and Commonwealth Fund Senior Vice President Cathy Schoen. “We now have 75 million Americans who are uninsured or underinsured. Poor access pulls down quality and drives up costs of care. The U.S. leads the world on health care spending – we should expect a far better return on our investment.”
Measured against benchmarks of achieved performance, the scorecard estimates that the U.S. health care system could save 100,000 lives and up to $100 billion annually if it improved performance on key indicators.
Reducing health insurance administrative costs to the average level of countries with mixed private/public insurance systems such as Germany, the Netherlands and Switzerland, the report notes, would free up $51 billion annually, or more than half the cost of providing comprehensive coverage to all the nation’s uninsured.
Reaching the lowest rate benchmarks (2 to 3 percent of national health expenditures spent on administrative costs) set by the lowest countries – Finland, Japan, and Australia – could save an estimated $102 billion per year, the report shows.
“It’s apparent that, overall, the health care system is performing unevenly and well below its potential,” said Dr. James J. Mongan, chairman of the 19-member Commonwealth Fund Commission on a High Performance Health System and CEO of Partners HealthCare in Boston. “While there are pockets of improvement and excellence, it is clear that we need strong leadership and concerted public and private efforts to achieve and raise standards of performance nationwide and ensure that significant progress occurs in the future.”
The report does offer some good news: For example, hospital standardized mortality ratios, a key indicator of patient safety, improved by 19 percent over five years, following broad public and private efforts to assess and improve hospital safety.
Chronic care and acute hospital care quality metrics that have been the focus of public reporting, pay for performance, and improvement efforts also showed significant progress, though some of the improvement was offset by an increase in visits for adverse drug effects, an increase in hospitalization of nursing home patients, and deterioration in care.
The full report is available here: www.commonwealthfund.org/publications/publications_show.htm?doc_id=692682..