U.S. Health-Care System Gets a "D"
The U.S. health-care system is doing poorly by virtually every measure. That's the conclusion of a national report card on the U.S. health-care system, released Sept. 20. Although there are pockets of excellence, the report, commissioned by the non-profit and non-partisan Commonwealth Fund, gave the U.S. system low grades on outcomes, quality of care, access to care, and efficiency, compared to other industrialized nations or generally accepted standards of care. Bottom line: U.S. health care barely passes with an overall grade of 66 out of 100.
The survey was carried out by 18 academic and private-sector health-care leaders, who rate the system on 37 different measures. The poor grade is particularly discomfiting, the researchers note, because the U.S. spends more on medicine, by far, than any other country. Approximately 16% of the nation's gross domestic product (GDP) is devoted to health care, compared with 10% or less in other industrialized nations.
Health care is also responsible for most new job creation, according to BusinessWeek's Sept. 25 cover story (see BusinessWeek.com, 9/25/06, "What's Really Propping Up The Economy"). Yet the U.S. ranks 15th out of 19 countries in terms of the number of deaths that could have been prevented. The study estimates that each year 115 out of 100,000 U.S. deaths could have been avoided with timely and appropriate medical attention. Only Ireland, Britain, and Portugal scored worse in this category, while France scored the best, with 75 preventable deaths per 100,000.
The U.S. ranks at the bottom among industrialized countries for life expectancy both at birth and at age 60. It is also last on infant mortality, with 7 deaths per 1,000 live births, compared with 2.7 in the top three countries. There are dramatic gaps within the U.S. as well, according to the study. The average disability rate for all Americans is 25% worse than the rate for the best five states alone, as is the rate of children missing 11 or more days of school.
The report found that quality of care and access to care varied widely across the country, and it noted substantial gaps between national averages and pockets of excellence. The authors concluded that, if the U.S. improved and standardized health-care performance and access, approximately 100,000 to 150,000 lives could be saved annually, along with $50 billion to $100 billion a year.
The Commonwealth Fund, which studies health-care issues, commissioned the report last year as part of an effort to come up with solutions to the nation's troubled health-care system. The report "tells us that overall we are performing far below our national potential," says Dr. James J. Mongan, chairman of the team that pulled together the study and chief executive officer of Partners Healthcare in Boston. "We can do much better and we need to do much better," he says.
Among the reports' findings:•Only 49% of U.S. adults receive the recommended preventive and screening tests for their age and sex.
•Only half of patients with congestive heart failure receive written discharge instructions regarding care following hospitalization.
•Nationwide, preventable hospital admissions for patients with chronic health conditions such as diabetes and asthma were twice as high as the level achieved by the best performing states.
•Hospital 30-day re-admission rates for Medicare patients ranged from 14% to 22% across regions.
•One-third of all adults under 65 have problems paying their medical bills or have medical debt they are paying over time.
•Only 17% of U.S. doctors use electronic medical records, compared with 80% in the top three countries.
•On multiple measures across quality of care and access to care, there is a wide gap between low income and the uninsured, and those with higher incomes and insurance. On average, measures for low income and uninsured people in these areas would have to improve by one-third to close the gap.
•As a share of total health expenditures, insurance administrative costs in the U.S. were more than three times the rate in countries with integrated payment systems.
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