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U.S. Again Scores Low in Quality, Efficiency, Access of Health Care System

By Reed Cooley, CQ Staff

July 17, 2008 -- The U.S. health care system has not improved and has even declined in some areas in recent years, but "wide opportunities to improve care" and save billions of dollars still stand well within the reach of stakeholders, according to the authors of a new report commissioned by the Commonwealth Fund.

The United States scored 65 out of a possible 100 on a scorecard evaluating 37 areas of the health care system, a two-point drop from a previous study in 2006. The report evaluated health systems around the world in the categories of healthy lives, quality, access, and efficiency and found that the U.S. system could save 100,000 lives and $100 billion if it met certain benchmarks in each area.

"While there are pockets of improvement and excellence, it is clear that we need strong leadership and concerted public and private efforts to achieve and raise standards of performance nationwide and ensure that significant progress occurs in the future," said James J. Mongan, chairman of the study's commission and CEO of Partners HealthCare in Boston.

Researchers found that the U.S. health care system suffers from a severe dearth of efficiency, a category in which the United States received a score of 53 out of 100. Although use of electronic medical records among U.S. physicians spiked from 17 to 28 percent between 2001 and 2006, the United States still lagged behind five other industrialized countries in this area, according to the report. Superior scores ranged from 42 percent in Germany to 98 percent in Netherlands, and, among those surveyed, only Canada received a lower score, at 23 percent, it said.

However, Commonwealth Fund officials pointed to access as the biggest problem with America's health care system and said that it should be the priority target area for a new administration and the next Congress.

"Whenever you look outside the U.S., one of the core differences you see is everyone is in the health care system," said Cathy Schoen, the Commonwealth Fund's senior vice-president and the study's lead researcher.

The study recorded a nine point decline since 2006 in the United States' access to care score, from 67 to 58 out of 100. The biggest reason for this drop was a spike in the number of Americans who went underinsured as opposed to uninsured, researchers said. Another Commonwealth Fund report, released last month, found that the number of Americans "insured but poorly protected" rose by 60 percent from 2003 to reach 25 million people in 2007, a year in which 37 percent of health care consumers reported going without needed care.

"We now have 75 million Americans who are uninsured or underinsured. Poor access pulls down quality and drives up costs of care. The U.S. leads the world on health care spending—we should expect a far better return on our investment," Schoen said in a press release.

Schoen and others praised state and local efforts to improve quality and access to care, but said that only a coordinated, "top-down" effort would allow the United States to reach the benchmarks necessary to save lives and cut costs on a significant scale.

They pointed to the next administration as the next opportunity to begin this effort.

When asked which presidential health care plan she would support, Commonwealth Fund President Karen Davis did not immediately express a preference. She noted similarities between the plans of Sens. John McCain, R-Ariz., and Barack Obama, D-Ill., in terms of their cost containment strategies and support of health information technologies, but said they differ in how they would expand access.

When pressed, Davis said, "On coverage, Obama's plan is preferable."

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