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Framework for a High Performance Health System for the United States

Health Providers


The United States has some of the best-equipped hospitals and best-trained physicians in the world. With much dedication to helping patients, they often provide extraordinary care. Nevertheless, the evidence clearly shows that, overall, the performance of the U.S. health care system falls far below the level it can and should achieve. On many dimensions of performance—from timely access to needed services to the deployment of health information technology—we lag behind other industrialized nations. Within our own borders, there are wide disparities from region to region and from state to state.

We spend more on health care than any other country. But we allocate our resources inefficiently and wastefully, failing to provide universal access to care and failing to achieve value commensurate with the money spent. In the U.S., many patients receive treatments and procedures known to be ineffective, while other effective treatments are vastly underused. Tens of thousands die annually from preventable errors. Nearly half of all adults worry they will not be able to pay their medical bills if they become seriously ill, will not get high-quality care, or will experience a medical error.

At the same time, we also know that throughout the country there are examples of health care providers and health plans, and innovative policies and programs, that perform much better than the national average.

The Commonwealth Fund's Commission on a High Performance Health System seeks to chart a course for a health care system that provides significantly expanded access, higher quality, and greater efficiency for all Americans, especially the most vulnerable members of society. Chaired by James J. Mongan, M.D, the 18-member Commission draws from all parts of the health care system—from health care delivery to health insurance—as well as the state and federal policy arena, the business sector, professional societies, and academia. The Fund's Board of Directors established the Commission in July 2005, recognizing the need for leadership in advancing promising strategies for health system improvement.

In this statement, the Commission first defines "high performance" and outlines its vision of a uniquely American, high performance health system. It then identifies the most critical sources of system failures and offers a strategic framework for addressing those failures. While the Commission's work has only begun, this consensus statement represents a significant first step, as it will guide future recommendations for specific actions.

The Commission anticipates that realizing its vision will require significant departures from current practice. Moreover, it demands an accelerated rate of innovation and improvement. The health, social, and economic costs of maintaining the status quo, or moving slowly, are far too great. Failure to improve the health care system will result in needless mortality and morbidity, excess costs and unnecessary expenditures, and, potentially, significantly diminished economic output at a time when the nation urgently needs a healthy and productive workforce. Our nation is both capable of and obligated to improving the health and well-being of all who live here.

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Publication Details



The Commonwealth Fund Commission on a High Performance Health System, Framework for a High Performance Health System for the United States, The Commonwealth Fund, August 2006