Information and Resources

Report: U.S. Health Care Not So Healthy

July 18, 2008 -- The overall health of the nation's health system is no better than it was two years ago -- and appears to have gotten slightly worse, according to a national scorecard.

The report was published by the Commonwealth Fund, a nonprofit health care think tank that supports universal health coverage.

The scorecard shows that people's access to insurance continues to slip. Seventy-five million adults of working age (42%) lack health insurance or are uninsured. In 2003, that number was 61 million (35%).

The scorecard grades the U.S. health care system on 37 indicators in five areas of health system performance, including healthy lives and access to insurance and care.

In 2008, nearly every score fell or stagnated from where it was in 2006, according to the Commonwealth Fund. The overall score dropped from 67 in 2006 to 65 in 2008.

"We need to change the way the U.S. health care system is financed, organized, and delivered," says Karen Davis, the Commonwealth Fund's president.

Scott P. Serota, CEO of the Blue Cross and Blue Shield Association, reacted to the report by noting that as much as 30% of health spending goes to ineffective or repetitive care. His group, which represents 39 Blue Cross plans nationwide, wants to cut costs by paying hospitals and doctors based on the quality of the care they deliver.

"Our system is spending blindly on procedures, devices, and drugs without any real information about what works best and what is most effective. This approach is not sustainable and a system that is not embracing best practices today cannot be expected to provide optimal coverage to nearly 50 million more people," Serota tells WebMD.

Crunching the Health Care Numbers

The study gets its scores by comparing the U.S. overall with averages in the best-performing states, or in some cases, foreign countries.

It shows a huge jump in the number of people without health coverage, and in the number of people who are exposed to financial ruin because of high health costs and inadequate insurance. Forty-one percent of U.S. adults have "problems" with medical bills or outstanding medical debt, up from 34% two years before. At the same time, around 60% of those people experience financial problems with medical costs despite having health coverage, according to the report.

"Whenever you look outside the United States, one of the core differences you see is that everyone is in the health care system," says Cathy Schoen, a Commonwealth Fund senior vice president. "When we look outside our borders, people don't go broke when they get sick."

The report shows only about half of U.S. adults got recommended preventive care (such as vaccines, blood pressure checks, and cancer screenings) in 2005, the latest year from which data are available. It also shows getting care after hours or on weekends without going to an emergency room is a much harder prospect for Americans than for people in other countries.