he United States provides some of the best medical care in the world. We spend more on health care than anyone else. And our health system is in serious trouble. By now, most of us have heard about the problems: tens of millions of Americans without health insurance coverage; an employer-based coverage system in distress; spiraling insurance and health care costs; high variability in the quality and safety of care; disparities based on race, ethnicity, and income.
In establishing the Commission on a High Performance Health System in 2005, The Commonwealth Fund's board of directors recognized the need for national leadership to revamp, revitalize, and retool the U.S. health care system. The Commission's 19 members
—a distinguished group of experts and leaders representing every sector of health care, as well as the state and federal policy arena, the business sector, professional societies, and academia—are charged with promoting a high-performing health system that provides all Americans with affordable access to high-quality, safe care while maximizing efficiency in its delivery and administration. Of particular concern to the Commission are the most vulnerable groups in society, including low-income families, the uninsured, racial and ethnic minorities, the young and the aged, and people in poor health.
During its inaugural year, the Commission ignited considerable public interest and attention. Its greatest accomplishments so far have been to highlight for the public specific areas where health system performance falls short of what is achievable, and to make the case for a holistic approach to reforming health care.
The group's first tasks are to 1) define the dimensions of performance in which the U.S. health system should excel, and 2) develop a clear framework of attributes that would lead to high performance. Completion of the first task will lay the groundwork for an annual "scorecard" that measures health system performance in each dimension and will help in setting short-, medium-, and long-term goals for improvement. The second step will enable the Commission to consider the policies and practices that are most critical to achieving its goals, as well as to determine how best to move these onto public and private agendas.