Commonwealth Fund: U.S. healthcare system gets low scores

Despite pockets of improvement, the U.S. healthcare system as a whole failed to improve when compared to best performers in the U.S., 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 New York City-based nonprofit added.

The report also found significant erosion in access to care and affordability of care, as healthcare costs rose far faster than family incomes.

The report, “Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2011,” measured the U.S. healthcare system across 42 key indicators of healthcare quality, access, efficiency, equity and healthy lives. The scorecard compared U.S. average performance to rates achieved by the top 10 percent of U.S. states, regions, health plans, hospitals, 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. The authors noted that latest data in the scorecard primarily fall between 2007 and 2009, before enactment of the Patient Protection and Affordable Care Act.

At the same time, the scorecard highlighted some bright spots for the U.S., with notable gains in quality of care in areas that have been the focus of public reporting or collaborative improvement initiatives. For example, 50 percent of adults with high blood pressure had the condition under control in 2007-2008, compared with only 31 percent in 1999-2000. Additionally, 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 scorecard found that the U.S. is failing to keep up with gains in health outcomes made by other countries: the U.S. ranks last out of 16 countries when it comes to deaths that could have been prevented by timely and effective medical care. If the U.S could do as well as the leading country, as many as 91,000 fewer people would die prematurely every year, CFC stated.

According to the scorecard, public reporting of quality data on federal websites and collaborative initiatives have resulted in substantial and rapid improvements on some quality indicators. For example:

• The proportion of home healthcare patients who gained improved mobility grew from 37 percent to 47 percent from 2004 to 2009.
• Ninety-six percent of hospitals reported providing the right care to prevent surgical complications in 2009, up from 71 in 2004.

“Despite these improvements, quality of care still varies widely across the country,” the report added. “Despite a 13 percent drop in hospital admissions for heart failure and pediatric asthma from 2004 to 2007, rates vary twofold to fourfold across states.”

Access to healthcare and healthcare affordability stand out for how quickly and significantly they deteriorated. By 2010, 81 million adults–44 percent of all adults under age 65–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 people lived in a state where health insurance premiums averaged less than 15 percent of median incomes. By 2009, only 4 percent of the population lived in such states.

In addition, by 2010, 40 percent of working-age adults had medical debt or faced problems paying medical bills up from 34 percent in 2005.

The U.S. also did poorly on measures of health system efficiency, scoring only 53 out of a possible 100. This area of the scorecard includes such issues as evidence of duplicative services, high rates of hospital readmissions, relatively low use of electronic information systems and high administrative costs. The scorecard finds that the U.S. could save $55 billion a year if it could lower insurance administrative costs to the average of administrative costs in other countries with mixed public-private insurance systems.

The scorecard identified pockets of high performance which illustrate the potential for the nation if others could learn from these high performers. Improvements would add up to significant gains in lives and dollars saved. For example, if the entire nation could do as well as the top performers:

• Thirty-eight million more adults would have a primary care doctor and 66 million more would receive all recommended preventive care.
• Up to 91,000 fewer people would die before age 75 each year of conditions amenable to healthcare, include screenable cancers, diabetes and infections.

“Successful implementation of reforms will require stakeholders at all levels to adopt a coherent, whole-system approach in which goals and policies are coordinated to achieve the best results for the entire population,” the report concluded. “By integrating all components of the health system to ensure better access, higher quality and greater value, we would be far more able to safeguard the health and economic security of current and future generations.”

The report is available here.