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A Need to Transform the U.S. Health Care System: Improving Access, Quality, and Efficiency

To see a slide show with an overview of the chartbook, click on the graphic below. Note that the show will open in a separate window; you might not be able to see the slides if you have a pop-up blocker active.

The need for fundamental transformation of the U.S. health care system has become increasingly apparent. Research reveals a fragmented system fraught with waste and inefficiency. Among industrialized nations, the United States spends well over twice the per capita average. High spending, however, has not translated into better health: Americans do not live as long as citizens of several other industrialized countries, and disparities are pervasive, with widespread differences in access to care based on insurance status, income, race, and ethnicity.

Particularly problematic is the large number of individuals lacking ready access to health services. Over a third of the population is uninsured, unstably insured, or underinsured. With health care costs on the rise, affordability is a key concern for many working families. Gaps in insurance coverage and high out-of-pocket spending hinder patients' access to care and lead to skipped medical tests, treatments, and follow-up appointments. In turn, these access problems produce preventable pain, suffering, and death—as well as more expensive care.

There are also significant issues with the safety and quality of care. As many as 98,000 deaths result annually from medical errors, and U.S. adults receive only 55 percent of recommended care. Inefficiencies, such as duplication and use of unnecessary services, are costly and compromise the quality of care. High administrative costs in health insurance and health care delivery are also problems.

Each chartbook section further illustrates the need to improve coverage, quality, and efficiency. The charts presented paint a stark picture of a health system in need of reform. Clearly, moving the nation toward a high performance health system will require collaboration. That is why The Commonwealth Fund has formed the Commission on a High Performance Health System: to identify public and private strategies, policies, and practices that would lead to improvements in the delivery and financing of health care for all Americans.

Publication Details



A Need to Transform the U.S. Health Care System: Improving Access, Quality, and Efficiency, Anne Gauthier, M.S., and Michelle Serber, The Commonwealth Fund, October 2005