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U.S. Health Care Still Ill, Survey Finds

Lack of access to insurance called a primary stumbling block

THURSDAY, July 17 (HealthDay News) -- Access to health care in the United States continues to elude more and more Americans, a new survey shows.

What's more, since the first "scorecard" was done in 2006, the nation's health-care system hasn't improved overall, even though the United States spends more on medical care than any other industrialized nation.

These are some of the findings in the Commonwealth Fund report called Why Not The Best? Results From The National Scorecard on U.S. Health System Performance, 2008.

"Despite the best efforts of millions of talented and dedicated health-care professionals, this latest scorecard demonstrates that we are losing ground," Karen Davis, president of the Commonwealth Fund, said during a Wednesday teleconference.

Davis said affordable health insurance must be extended to all. Also, the way Americans pay for health care needs to be changed to reward doctors and hospitals that offer high quality care, she said.

In the report, the authors compared average performance in the United States to performances by top-rated performers across the country and abroad.

"Overall, we find a failure to improve, with steep declines in access with growing numbers of uninsured and underinsured and ever less affordable care," Cathy Schoen, the Commonwealth Fund's senior vice president for research and evaluation, said during the teleconference.

"Overall, the U.S. score averages just 65 out of a possible 100, falling far short of benchmarks with wide gaps in all dimensions of the health system," Schoen said. The score was lower than that achieved in the 2006 scorecard, she added.

Scores for efficiency were particularly low, Schoen said, "held down by fragmented, poorly coordinated care; lack of access that leads to avoidable hospitalizations; variations in costs with no return in quality; lack of investment in information technology; and very high insurance overhead costs."

When it comes to access to and affordability of health care in the United States, the numbers seem to be moving in the wrong direction, according to the scorecard. In 2003, 35 percent of working-age adults either had no health insurance or were underinsured; by 2007, that number had risen to 42 percent.

The United States also lags behind other countries in health-care results, Schoen said. "Even where the U.S. average improved, other countries have improved much more rapidly," she said. "As a result, we are falling further behind the leaders."

For example, the United States is now last among 19 industrialized nations in premature deaths that might have been prevented by better access to health care. In 2006, the United States was 15th on the list.

The scorecard also contended that 100,000 lives -- and some $100 billion -- could be saved each year if health care were improved in the United States.

The scorecard also found that health care varies widely from state to state, region to region, and from one hospital and health plan to another. The difference between the best and worst performers can be as much as fivefold, according to the scorecard.

On the positive side, mortality rates in hospitals improved 19 percent over the past five years. This gain was the result of concentrated public-private efforts to improve hospital safety, according to the report.

While there have also been improvements in the care given in hospitals, some of those improvements have been offset by an increasing number of adverse drug events, and more hospitalizations of nursing home patients and deterioration in timely patient care, according to the report.

Other findings of the scorecard include:

  • Basic preventive care hasn't improved, with only 50 percent of all adults receiving recommended preventive care, such as cancer screenings.
  • Health insurance premiums continue to rise faster than wages. In 2007, 41 percent of adults said they had medical debt or trouble paying medical bills, up from 34 percent in 2005.
  • The number of primary-care doctors using electronic medical records rose from 17 percent in 2001 to 28 percent in 2006. But this gain still lags some other countries where 98 percent of doctors use electronic records.
  • Disparities in health care continue to be pervasive, with minority, low-income and uninsured adults more likely to wait to see a doctor and encounter delays and poorly coordinated care. Also, they have worse dental care, more uncontrolled chronic disease, more avoidable hospitalizations, and worse outcomes.

According to the scorecard, if the U.S. health care system were improved to the level of some other industrialized nations, then:

  • Thirty-seven million more Americans would have access to primary care, and 70 million more would receive preventative care.
  • Medicare could save $12 billion a year through reduced hospital admissions and hospitalizations for preventable conditions.
  • $51 billion a year could be freed up if health insurance administrative costs were reduced.

More information

To learn more about health care in the United States, visit the Commonwealth Fund.

SOURCES: July 16, 2008, teleconference with Karen Davis, president, The Commonwealth Fund, New York City; Cathy Schoen, senior vice president for research and evaluation, The Commonwealth Fund; Commonwealth Fund report, Why Not The Best? Results From The National Scorecard on U.S. Health System Performance, 2008

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