Certainly the most significant contribution the Commission has made thus far is the National Scorecard on U.S. Health System Performance. Despite its name, the Scorecard is no game. The first-ever comprehensive, evidence-based means of measuring and monitoring health system performance, the Scorecard assesses how well the U.S. does across the key areas of health care relative to achievable benchmarks. It also points to deficient areas where public and private action is needed—and provides a yardstick against which to measure the success of new policies.
Published both as a
Health Affairs Web Exclusive
(3) and a Fund report,
(4) the findings show that across 37 indicators of performance—from receipt of preventive care by children to hospital admission rates for nursing home residents—the U.S. attains an average score of just 66 out of a possible 100, based on ratios of national performance to the best-attained performance within the U.S. or abroad. Given our nation's wealth and high level of health spending, that is simply unacceptable. Following are some of U.S. health care's specific shortcomings:
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U.S. mortality rates from conditions "amenable to health care"—deaths that could have been prevented with timely and effective care—are 30 percent higher than in the three best-performing countries. |
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Barely half of adults receive preventive and screening tests according to guidelines for their age and sex. |
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If national average rates for control of diabetes and blood pressure matched rates achieved by the top 10 percent of U.S. health plans, an estimated 20,000 to 40,000 deaths and $1 billion to $2 billion in medical costs could be avoided. |
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Only 17 percent of U.S. doctors have an electronic medical record system in place; in the top three countries, 80 percent of doctors have one.
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It would require a 20 percent decrease in Hispanic risk rates for such problems as being uninsured, lacking a regular source of primary care, and not receiving essential preventive care to reach the rates experienced by whites.
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The Commission estimates that closing the gaps in performance described in the Scorecard could save at least $50 billion to $100 billion per year in health care spending and prevent 100,000 to 150,000 deaths. To do that, the nation first must have a coherent strategy for simultaneously achieving better access, quality, and efficiency. Covering the nation's 46 million uninsured is one component. But of equal importance is identifying and adopting successful programs and practices that have already been shown to improve patient care while keeping costs down.
Commission members and Fund staff presented the Scorecard results at a well-attended briefing in
Washington, D.C. Just weeks following its release, the report,
Why Not the Best? Results from a National Scorecard on U.S. Health System Performance, was already the most-viewed publication ever posted on the Fund site. Moreover, organizations including the Institute of Medicine, the American Board of Internal Medicine, the New York City Department of Health and Mental Hygiene, and Blue Cross Blue Shield of Massachusetts have requested copies for their members and staff.
