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Journal Article


Aiming High for the U.S. Health System: A Context for Health Reform

An abstract is available at:

This article presents an overview of results from The Commonwealth Fund's 2008 National Scorecard on Health System Performance, which finds U.S. performance well behind benchmarks set by other countries, as well as those achieved by high performing states, hospitals, or health plans within the United States. In 2008, the U.S. scored 65 out of 100 on indicators reflecting key dimensions of performance—quality, access, efficiency, equity, and health outcomes. On one critical indicator—mortality amenable to health care, a measure that includes deaths before age 75 for conditions that could be prevented by effective health care—the U.S. fell to last place (from 15th when the Scorecard was originally published in 2006) among the 19 industrialized countries in the analysis. While U.S. performance is generally substandard in the domains measured, one bright spot exists: self-management of chronic disease. Among U.S. adults with chronic conditions like heart disease or diabetes, 58 percent said their doctor gave them a management plan to follow at home. This relatively high performance was second only to that of Canada. The article suggests several ideas for improving value and enhancing access, including the Building Blocks proposal, which works with the current U.S. private–public system by expanding group coverage through private markets and publicly sponsored insurance, and the policy options put forth in the Fund's Bending the Curve report. "Policy changes that will improve quality and enhance value obtained for health spending should be pursued simultaneously with expanded insurance coverage—both to ensure affordability and sustainability of the system," the authors conclude.

Publication Details



K. Davis, C. Schoen, K. Shea, and C. Haran, "Aiming High for the U.S. Health System: A Context for Health Reform," Journal of Law, Medicine & Ethics, Winter 2008 36(4):629–43.