The Commonwealth Fund, a New York based healthcare foundation, released its National Scorecard, 2011, which updates a series of national assessments that measure and monitor population health, quality, access, efficiency, and equity in the U.S. After assessing 42 healthcare indicators of quality, access, cost, performance and other measures, the U.S. scored 64 out of 100 on its performance compared to best performing countries, states,regions, and healthcare plans. In 2006, the Fund’s first report gave the U.S. a score of 67, followed by 65 in 2008.
The scorecard portrays a unique assessment of the ways in which the nation’s healthcare system is underperforming and failing, and shows the areas it has gotten better. The scorecard showed improvements in quality-of-care indicators that were the focus of public reporting and other initiatives.
Promising improvements were noted in effective care for chronic conditions like high blood pressure control, hospital performance in preventing complications from surgery, and treating heart attacks, heart failure, and pneumonia. Preventable hospitalizations dropped by 13 percent probably due to improved disease management. Cigarette smoking dropped to 17 percent in 2010 from 20 percent in 2004, with Utah and California exceeding the Healthy People Goal 2010 of 12 percent. However, the rate of deaths that might have been prevented with timely and effective care—improved 21 percent in the U.S. between 1997–98 and 2006–07 (from 120 to 96 deaths per 100,000). Nevertheless, rates improved by 32 percent, on average, in 15 other industrialized nations, with U.S. at the bottom of the list with a rate 68 percent higher than the rate in the leading countries.
The U.S. does poorly in how efficiently healthcare resources are utilized, treatments are wasted, while limiting administrative costs. Nearly 44 percent of adults, 81 million, were either uninsured or underinsured but had medical bills that were high relative to their incomes. Rate of re-hospitalization for some conditions were as high as 20 percent.
Indicators that raise serious concern are infant mortality, childhood obesity, safe care, patient-centered care, and disparities in care.
The Commonwealth Fund report argues that “fundamental to a high-performing health care system is having ample capacity to innovate and improve.” This requires a skilled healthcare workforce, payment and insurance benefits that motivate consumers to make optimal use of the system, continued quality improvement, public health initiatives, and research. Some of these issues will be addressed by the Affordable Care Act that makes investments in prevention and provides incentives to encourage physicians to select and maintain primary care careers.
The report states that “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. 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.”