According to the 2008 National Scorecard on U.S. Health System performance, America's health system continues to fall short of its healthcare goals regardless of resources invested.
The scorecard, which was prepared by the Commonwealth Fund Commission, found that across 37 core indicators of performance, the United States scored a 65 out of a possible 100 when comparing national averages with U.S. and international and performance benchmarks.
The first scorecard came out in 2006, offering a way to measure and monitor healthcare outcomes, quality, access, efficiency and equity in the United States. According to the 2008 scorecard, overall performance has not improved since then.
As of 2007, 75 million adults ages 19-64 - or 42 percent of all adults - were underinsured or uninsured. This represents a 35-percent increase since 2003, the report finds.
When compared with other major industrialized countries, the United States spends double per capita on healthcare, and costs are rising faster than income. The report predicts that $1 of every $5 of national income will go toward healthcare.
"The scorecard tells us that we are losing ground in crucial areas like access to healthcare," 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 healthcare spending - we should expect a far better return on our investment."
The scorecard finds that performance on health system efficiency remains low. The United States scored a 53 out of 100 on measures gauging inappropriate, wasteful, or fragmented care; avoidable hospitalizations; variation in quality and costs; administrative costs; and use of information technology.
Reducing insurance administrative costs alone could save up to $100 billion a year at the lowest country rates, the report says.
In order to reach benchmark levels of performance, the United States would have to improve by more than 50 percent across multiple indicators. If these gaps could be closed, the study suggests that:
- $12 billion a year could be saved by the Medicare program by reducing readmissions or hospitalizations for preventable conditions.
- Reducing health insurance administrative costs to the average level of countries with mixed private/public insurance systems would free up $51 billion, or more than half the cost of providing comprehensive coverage to all the uninsured in the United States.
- Reaching benchmarks of the best countries would save an estimated $102 billion per year.
"It's apparent that, overall, the healthcare system is performing unevenly and well below its potential," said James J. Mongan, MD, 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."