Evaluating Healthcare in America

According to a comprehensive new report by the Commonwealth Fund,(1) the healthcare system in the U.S. is, in general, declining. This year, the U.S. received a score of 64 out of a possible 100. In 2006, the U.S. got a 67 out of a possible 100, and in 2008 it earned a 65.

The report, entitled “Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2011,” covers key health indicators from the years 2008-2009, and is the third installment of the series that began in 2006.

This year, the U.S. received a score of 64 out of a possible 100. In 2006, the U.S. got a 67 out of a possible 100, and in 2008 it earned a 65.

The researchers, gathered from various hospitals and research institutions across the country, considered 42 key measures of healthcare in five different areas reflecting financial, medical and human considerations:

• Healthy Lives included variables having to do with life expectancy, mortality, and the prevalence of certain factors like smoking, and childhood overweight or obesity.
• Quality measured how well medical care delivered its goals and whether it is “well coordinated, safe, timely, and patient-centered.”
• Access determined whether health care and health insurance were available to patients.
• Efficiency looked at how smoothly operations run in the health business, including how often preventable readmissions to hospitals occur and whether facilities are using information systems.
• Equity assessed how different groups of patients are treated in the healthcare system.

The main message of the report is that healthcare costs are rising but they are simply not matched by improvements in the care people receive. In other words, breaking it down to the most fundamental issues, there are two problems: Cost and care.

The cost of healthcare is rising faster than the average American income, which leaves many people without access to insurance and health care at all.

The total cost of healthcare – which includes everything from primary care and preventative medicine to the treatment of chronic diseases to hospitalization and long term care – is rising faster than we can keep up, according to the report.

The U.S. spends twice per capita what other countries spend. The authors of the report comment that “U.S. health system performance continues to fall far short of what is attainable, especially given the enormity of public and private resources devoted nationally to health.” The cost of healthcare is rising faster than the average American income, which leaves many people without access to insurance and health care at all.

Beyond the issue of cost, the quality of the care in the U.S. seems to be suffering. Measures like infant mortality and the number of unnecessary rehospitalizations indicate that the U.S. still has a long road ahead. That said, there were some bright spots, signs that we may be on the right track, at least in some ways. For example, the U.S. is gaining ground in the management of certain chronic diseases and in the quality of long term care, both of which are important markers for healthcare quality.

The authors argue that the Affordable Care Act will, and has already begun in some ways, to change the state of the heath care system in the U.S. How far-reaching its effects will be remains to be seen.