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Evaluating Healthcare in America
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Evaluating Healthcare in America


Taking the First Steps
But there is a silver lining: the situation has begun to improve. In the same way that shortcomings in the system perpetuate one another, improving just one area of health care can set in motion a positive chain of events, with multiple areas showing improvement as the result of a single change.

The report's authors argue that the Affordable Care Act (ACA) Act has already facilitated access to care, which is an important step. For example, adults up to 26 years of age can now be insured under their parents’ policies. This has allowed an additional one million people health coverage. When the Act is in full effect the authors calculate the country’s average insurance coverage rate should match the level of the best-insured states.

Other nations have stronger health care systems in part because they are smaller and have been utilizing other methods for years or decades.

Yet to be accomplished, but hand in hand with access to care, improving primary care is the second critical step. Better primary care could theoretically affect everything from the management of chronic conditions to the prevention of unnecessary rehospitalizations to the avoidance of emergency room visits. Beginning with these couple of changes (which are admittedly not small ones) we should start moving things in the right direction.

The Changes We Should Expect
If the United States were able to meet the same benchmarks for healthcare as other developed countries, the authors project we would see:
  • 91,000 fewer people dying prematurely each year.
  • 38 million more adults with access to a primary care provider.
  • 66 million more adults receiving recommended preventive care.
  • A savings of $1.6 billion to $3.1 billion per year in medical costs as a result of improved control of diabetes and blood pressure and its related prevention of additional diseases and complications.
  • A savings of $144 billion per year if health insurance administrative costs were lowered; simply reducing the costs to the level of countries with mixed private–public insurance systems (like the U.S.) would free up $55 billion.

These projections are both inspiring and daunting. Clearly, a massive change in a massive country won’t happen over night. Other nations have stronger health care systems in part because they are smaller and have been utilizing other methods for years or decades. It’s clear that the American public is ready for change, and we are slowly making steps in that direction. Things have already started to improve, if slowly.

Time will tell how the Affordable Care Act will continue to improve the situation, and over what timeframe. It may need to be amended considerably as its effects become visible over the coming years, or additional measures may be necessary. But as the authors of the new report point out: "Although the task of moving to a system that is truly high performing is enormous, the stakes are even higher if we fail.”

The Commonwealth Fund Commission on a High Performance Health System, Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2011 can be viewed here.

November 16, 2011
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