U.S. Health System Gets Dismal Score
High Cost, Poor Efficiency, and Lack of Fairness Mar System
Sept. 20, 2006 -- In high school, 66% earns a "D" -- not quite bad
enough to fail, but still dismally below average.
And 66 is exactly the score the U.S. health system received in the most
comprehensive grading to date of areas such as access to care, quality, cost,
The score comes from the Commonwealth Fund, a nonpartisan health policy
think tank in Washington.
The group evaluated more than three dozen different measures to come up with
a composite score for American health care in relation to top-performing
nations -- or, in some cases, individual states.
The categories included areas such as long, healthy, and productive lives
(the U.S. scored a 69 on this), quality (71), access (67), efficiency (51), and
"Some might ask if it is a 'C,' [is it] an 'F'?" says James Mongan,
MD, chairman of the commission that issued the report. "To me … the message
is clear. We can do much better and we need to do much better."
Countless reports have detailed how the United States lags other nations --
some industrialized, and some not-so-industrialized -- in bellwether statistics
such as infant mortality and overall life expectancy.
But it's not for lack of money. The U.S. spends a far bigger chunk of its
economy on health care than any other nation, but has less and less to show for
The U.S. now spends more than $6,000 per capita on medical care, compared
with $2,000 to $3,000 spent by the U.K., Germany, Canada, and France.
But a major lack of efficiency and equity lead to rampant waste that
squanders resources that could be spent improving health, the commission's
A third of the adult population under 65 lacks adequate health insurance,
forcing them to seek more expensive care in hospital emergency rooms and other
That often precludes what the preventive care experts consider the gold
standard of health care.
The report stresses that the U.S. is not without quality, efficient
For example, the nation's best hospitals discharge 90% of heart attackpatients with written educational materials containing advice on how to
avoid another attack. Meanwhile, the national average is only 50%.
"The challenge, I think, is spread. It's a very fragmented system,"
says Maureen Bisognano, a member of the commission and executive vice president
of the Institute for Healthcare Improvement, a New York-based policy group.
Among the report's other findings:
Hospital and doctor care for heart attacks, hip fractures, and colon cancer now cost a median
of $26,000, though quality is largely unrelated to how much is spent.
The U.S. spends more than 3 times what France does administering health
insurance, as a percentage of overall medical spending.
Fewer than 20% of U.S. doctors use electronic medical records, among the
lowest rates in industrialized countries.
1/3 of American adults have outstanding medical debt.