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U.S. Health System Gets Dismal Score

High Cost, Poor Efficiency, and Lack of Fairness Mar System

By Todd Zwillich
WebMD Health News

Reviewed by Louise Chang, MD

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, and efficiency.

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 equity (71).

"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 it.

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 report suggests.

Fragmented Care

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 places.

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 care.

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.