U.S. Healthcare Gets Bad Grades on Scorecard

U.S. Healthcare Gets Bad Grades on Scorecard

By Emily P. Walker, Washington Correspondent, MedPage Today
Published: October 18, 2011

WASHINGTON -- The U.S. healthcare system is not improving much despite the fact that the cost of care is higher than ever, according to a national healthcare scorecard released by the Commonwealth Fund on Tuesday.

The U.S. scored a 64 out of 100 overall for key measures of healthcare performance that pitted the nation as a whole against high-performing regions in the U.S., as well as against other countries.

The nation's overall score has declined slightly since the organization's last such report in 2008.

The scorecard measures the U.S. healthcare system across 42 indicators of healthcare quality, access, efficiency, equity, and healthy lives, and compares U.S. averages to rates achieved by the top 10% of states, regions, health plans, hospitals, other providers, and other top-performing countries.

The U.S. had more preventable deaths that could have been prevented by timely and effective medical care than any of the other 15 industrialized countries included in the report.

The report also found that the average U.S. infant mortality rate is 35% higher than rates in the top-performing states in the U.S. Other high-income countries still have infant mortality rates that are significantly lower than the best-performing states in the U.S.

If the U.S. did as well as the top-performing country in that category -- France -- 91,000 fewer infants would die prematurely each year, Cathy Schoen, senior vice president at Commonwealth Fund told reporters in a Tuesday afternoon call.

"These statistics are real," she said. "They are real human lives."

Access also stood out in this year's report for how quickly and drastically it deteriorated, the report authors said. In 2010, 81 million adults were uninsured, up from 61 million in 2003.

And there's the cost issue. It's an oft-cited statistic that the U.S. spends more per person on healthcare than any other country. The Commonwealth Fund report said the nation spends up to double as much as other high-income countries, but doesn't have better care to show for it.

"We are headed toward spending $1 of every $5 of national income on healthcare," the report authors said. "We should expect a better return on this investment."

The high cost of healthcare is taking a toll on personal finances, the report found. By 2010, 40% of working-age adults had medical debt or had problems paying medical bills, up from 34% in 2005.

The bad news continued in the category of efficiency: The U.S. scored only 53 out of 100 in that category, which looked at whether patients were receiving duplicative services and whether hospitals had high readmission rates, among other indicators.

The report also found:
•44% of adults reported that they didn't have a primary care provider in 2008, and only half said they received all recommended preventive care. If the U.S. did as well as top performers, 38 million more adults would have a primary care doctor and 66 million more would receive all recommended preventive care.
•One-in-four elderly Medicare beneficiaries were prescribed a "potentially inappropriate drug."
•About one-third of kids ages 10 to 17 are overweight or obese.
• 20% of Medicare patients hospitalized for certain conditions or procedures were readmitted within 30 days in both 2003 and 2009.


But the report did note some improvements: there was more public reporting of quality data than in previous years; more hospitals adhered to recommended protocols to prevent surgical complications; the percentage of adults who smoke declined from 21% in 2004 to 17% in 2010; and a greater number of people were controlling their high blood pressure than in previous years.

Most of the data in the report came from 2007-2009, which was before the passage of the Affordable Care Act (ACA). The study authors point out that the law will likely lead to improved scores on some of the categories, such as access and affordability.

For instance, 25% of the population in 15 states lacked health insurance. But the ACA will require everyone have health insurance in 2014. It also will lower the threshold for Medicaid so more low-income people will be eligible, and provide government subsidies to others who can't afford to buy insurance on their own.

Also, the poor scores on primary care measures likely stem from the "nation's weak primary care foundation and from inadequate care coordination and teamwork." The ACA contains provisions to encourage team-based care, including accountable care organizations and giving primary care doctors bonus payments for coordinating care of their Medicare patients.