The Commonwealth Fund’s Commission on a High Performance Health System has issued its 2011 National Scorecard on U.S. Health System Performance, the third of these reports (prior reports were issued in 2006 and 2008). The Commission finds that U.S. health system performance continues to fall far short of what is attainable, especially given the enormity of public and private resources devoted nationally to health. Across 42 performance indicators, the U.S. achieves a total score of 64 out of a possible 100, when comparing national rates with domestic and international benchmarks. Overall, the U.S. failed to improve relative to these benchmarks, which in many cases rose. Costs were up sharply, access to care deteriorated, health system efficiency remained low, disparities persisted, and health outcomes failed to keep pace with benchmarks.
As of 2010, more than 81 million working-age adults—44 percent of those ages 19 to 64—were uninsured during the year or underinsured, up from 61 million (35%) in 2003. Further, the U.S. failed to keep pace with gains in health outcomes achieved by the leading countries. The U.S. ranks last out of 16 industrialized countries on a measure of mortality amenable to medical care (deaths that might have been prevented with timely and effective care), with premature death rates that are 68 percent higher than in the best-performing countries. As many as 91,000 fewer people would die prematurely if the U.S. could achieve the leading country rate.
The report also found that minorities and low-income or uninsured adults and children were generally more likely than their white, higher-income,or insured counterparts to wait to see a doctor when sick, to encounter delays and experience poorly coordinated care, and to have untreated dental caries, uncontrolled chronic disease, avoidable hospitalizations, and worse outcomes. And they were less likely to receive preventive care or have an accessible source of primary care.
Fortunately, the Affordable Care Act targets many of the gaps identified in the report, particularly access, affordability, and support for innovations to make care more patient-centered and coordinated.
A useful “chartpack” of the data from the report is also available: