Health Scorecard Ranks U.S. on Lower Rungs

America spends twice as much for health care as other industrialized nations. For that investment, the United States has bought the highest infant mortality rate among 23 industrialized nations; one of the lowest healthy life expectancy rates for people older than age 60, some of the highest insurance administrative costs and among the lowest use of electronic health records, or EHRs.

Those were among the findings of a report released in a Sept. 20 Health Affairs article by the Commonwealth Fund and a concurrent report, "Why Not the Best? Results From a National Scorecard on U.S. Heath System Performance," by the Fund's Commission on a High Performance Health System. The scorecard shows that, overall, the American health care system scored 66 out of 100 when compared to other industrialized countries on national benchmarks. The United States did not score the best in any indicator.

Many of the findings reflect the fragmentation of a health care system that provides sporadic health coverage and inadequate access to primary care medical homes, according to Cathy Schoen, senior vice president for research and evaluation at the Commonwealth Fund, and her colleagues in the Health Affairs article, "U.S. Health System Performance: A National Scorecard."

"High and rising rates of the population that is under- and uninsured destabilize the delivery system, fuel inefficient use of resources, and put families and the nation at risk of losing ground on past gains in health and workforce productivity," they write. "Fragmented and unstable coverage not only increases insurance overhead costs, it also undermines the nation's ability to assess outcomes or costs over time. …

"Lack of access to primary care, poor quality in hospitals and nursing homes or during transitions, and inadequate information systems contribute to duplicate efforts, inefficient use of specialized care and higher rates of hospital admission and readmission, which raise the costs of care and lead to poorer outcomes."

Among the scorecard's findings:

Improving access to primary care through both universal coverage and a health financing system that encourages the use of medical homes would resolve many of the U.S. health system woes, according to the Commonwealth Fund report.

"Financial incentives posed by the fee-for-service system of payment as currently designed undermine efforts to improve preventive and primary care, manage chronic conditions and coordinate care," the report says. "We need to devise payment incentives to reward more effective and efficient care, with a focus on value. …

"Payment policies that support integrated, team-based approaches to managing patients with multiple, complex conditions -- along with efforts to engage patients in care self-management -- will be of paramount importance as the population continues to age."

The scorecard is based on data gathered for the Commonwealth Fund Commission on a High Performance Health System. Commission researchers looked at 37 indicators for health outcomes, quality, access, equity and efficiency developed by the Institute of Medicine, HHS, the Agency for Healthcare Research and Quality and the National Committee for Quality Assurance.