President's Message
The Best Health System
in the World

1. What's Wrong: A Snapshot
2. Lessons from the Scorecard
3. What's Right: A Blueprint for Change

Printable version of this article
(18 pages)

The Commission's scorecard on U.S. health system performance focuses on five core goals:
1.Long, healthy, and productive lives;
2.High-quality care;
3.Access for all;
4.Efficient care; and
5.Equitable care.
The scorecard's data highlight areas within each category where the U.S. health system currently falls short.

1. Long, Healthy, and Productive Lives.
The overriding expectation for a health system is that it ensures the opportunity for a long, healthy, and productive life for everyone. The Commission scorecard includes indicators of mortality, healthy life expectancy, and health-related limitations faced by children and adults.
Poorer Health Outcomes, Higher Mortality. Across five indicators of health outcomes, the U.S. scores 69 compared with the benchmark performance of 100. On no indicator of health outcomes is the U.S. the best. The traditional excuse—that the U.S. population is "different"—is not convincing. The indicators were selected to focus on the effect of the health care system, not on health outcomes primarily related to socioeconomic determinants of health or health behaviors such as smoking or diet.
One indicator, for example, focuses on mortality from conditions "amenable to health care"—a measure of death rates before age 75 from diseases and conditions that are preventable or treatable with timely, effective medical care. The U.S. ranked 15th out of 19 countries, with a death rate 30 percent higher than France, Japan, and Spain.
Yet hidden in these sobering findings is a glimmer of hope: if all U.S. states performed at the same level as the five best performing states, the U.S. would be on a par with the best countries. Spreading proven best practices from a few pockets of excellence to the entire U.S. health system will be a critical step in improving outcomes.
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