Scoreboard: U.S. Health System Gets a 'D'

Sept. 20, 2006 — -- A new scorecard from a private foundation shows what the U.S. health care system is doing right and wrong, and it finds more on the minus side than the plus side.

The Commonwealth Fund Commission report, released today, ranks the performance of the U.S. health care system overall against top-performing health systems within the United States and against health care systems of other nations.

On the whole, the outcome looks rather grim. The United States scored a 66 out of a possible 100 points.

Experts said this score reflects a gap between how the United States is doing in delivering medical care and how top health care systems are doing around the world.

This scorecard signals an "urgency for action," said Cathy Schoen, senior vice president for research and evaluation at the Commonwealth Fund.

Some of the findings might seem surprising.

For every 100,000 Americans under the age of 75, 115 die from conditions that could have been prevented. In countries that ranked tops in preventive care, between 75 and 84 out of 100,000 die from preventable causes.

In the United States, seven infants die out of every 1,000 live births -- compared with fewer than three per 1,000 in the top- ranking countries.

The United States also scored low on quality of care. Only half the adults in the United States receive recommended preventive, screening tests.

The survey suggested that the problems run deeper than just routine care and screening.

Overall, only half of the Americans hospitalized for heart failure receive written instructions when they leave the hospital, even though at the top U.S. hospitals 87 percent get these home-care instructions. That means that most U.S. hospitals are doing a poor job getting information to their heart failure patients.

Americans also have a hard time obtaining medical care, according to the survey, because more than one-third of adults under 65 have no insurance or are not sufficiently protected from high costs, even though they might have some insurance.

"Poor access leads to poor quality of care, which leads in turn to higher costs," Schoen said.

If the U.S. health care system was more efficient, health care costs might not be so high, the report found.

According to the survey, Medicare could save $1.9 billion annually if hospitals gave a patient proper care on a first visit, because that would likely mean that fewer patients would have to be readmitted.

The survey's authors hope this report helps patients realize what kind of medical care they should expect to receive, and shows U.S. policymakers how they could begin to improve the country's health care system.