Despite areas of improvement, the U.S. healthcare system as a whole failed to improve between 2007 and 2009, according to a report released Oct. 18.
The national "scorecard” report, published by the Commonwealth Fund Commission on a High Performance Health System, measured the U.S. healthcare system across 42 key indicators of healthcare quality, access, efficiency, equity and healthy lives.
Across the 42 performance indicators, the U.S. achieved a total score of 64 out of a possible 100, when comparing national rates with domestic and international benchmarks. The 2011 score of 64 was slightly below the overall score of 67 in the first national scorecard published in 2006, and the score of 65 in the second scorecard, published again in 2008. The latest data in the scorecard mostly fall between 2007 and 2009, before the enactment of the Patient Protection and Affordable Care Act of 2010, which attempts to address issues of access to health services, affordability of care and quality of care.
Overall, from 2007 to 2009, costs were up sharply, access to care decreased, health system efficiency remained low, disparities persisted and health outcomes either deteriorated or failed to improve.
Among other developed nations in the study – including the United Kingdom, Canada, Australia and Germany – the scorecard found that the United States is failing to keep up with improvements that other countries have made in the area of health outcomes. Out of 16 countries, the United States ranked last when it comes to deaths that could have been prevented by timely and effective medical care.
Despite these dismal findings, quality initiatives are showing promise. For example, the proportion of home healthcare patients who gained improved mobility grew from 37 percent to 47 percent from 2004 to 2009. Also, 96 percent of hospitals reported providing the right care to prevent surgical complications in 2009, up from 71 percent in 2004.
But overall, the country’s score has slipped and the U.S. healthcare system has either improved less rapidly in some areas while growing worse or has actually grown worse in other sectors.
Access to healthcare and healthcare affordability have quickly and significantly deteriorated over the past several years. By 2010, 81 million adults – 44 percent of all adults under age 65 – were either underinsured or uninsured at some point during the year – up from 61 million in 2003.
For those with health insurance, premiums rose far faster than incomes. In 2003, a majority of people – 57 percent – lived in a state in which health insurance premiums averaged less than 15 percent of average household incomes. But by 2009, only four percent of the population lived in such states.
More individuals are also facing financial burdens related to the growing cost of medical care. By 2010, 40 percent of working-age adults had medical debt or faced problems paying medical bills. That’s up from 34 percent in 2005.
The scorecard also highlighted several areas of concern in the U.S. health system. For example, primary care and preventive care utilization was low, with 44 percent of adults reporting that they didn’t have an accessible primary care provider in 2008. The same year, only half of adults received all recommended preventive care, which is on par with what was reported in the 2006 scorecard.
Childhood obesity rates are also high, with about one-third of children ages 10 to 17 overweight or obese.
In addition, despite national efforts to reduce potentially preventable hospital readmissions, rehospitalization rates failed to improve. In both 2003 and 2009, 20 percent of Medicare patients admitted to a hospital for certain conditions or procedures were readmitted within 30 days.
In the category of health system efficiency, the U.S. also performed poorly, scoring a 53 out of a possible 100. This area of the scorecard includes such issues as evidence of duplicative services, high rates of hospital readmissions, relatively low use of electronic information systems and high administrative costs – factors that drive up costs to the healthcare system. But the scorecard found that the U.S. health system could save $55 billion a year if it could lower insurance administrative costs to the average level of administrative costs in other countries that also have mixed public-private insurance systems.