Ail­ing health sys­tem

Re­port slams U.S. ef­fort, notes gains

Modern Healthcare - - THE WEEK IN HEALTHCARE - Mau­reen Mck­in­ney

The U.S. health­care sys­tem is do­ing a dis­mal job de­liv­er­ing af­ford­able, ac­ces­si­ble and ef­fi­cient care, the Com­mon­wealth Fund con­cludes in a new re­port. The Com­mon­wealth Fund gave the na­tion’s health­care providers an over­all per­for­mance score of 64 out of a pos­si­ble 100, when com­pared with top per­form­ers across the U.S., and with other coun­tries, in “Why Not the Best? Re­sults from the National Score­card on U.S. Health Sys­tem Per­for­mance, 2011.”

That score slipped slightly from the or­ga­ni­za­tion’s two pre­vi­ous national per­for­mance re­ports. In 2006, the coun­try’s over­all score was 67 and in 2008, that num­ber fell to 65.

“I wasn’t re­ally sur­prised that the score dropped,” said Cathy Schoen, se­nior vice pres­i­dent of the Com­mon­wealth Fund. “We’ve been watch­ing these in­di­ca­tors over time so we knew that ac­cess had de­clined and pre­mi­ums are ris­ing faster than in­comes. We also know that ad­min­is­tra­tive costs have re­mained high, and we’re still lag­ging be­hind in health IT.”

The score­card as­sesses health sys­tem per­for­mance us­ing 42 in­di­ca­tors, cov­er­ing ar­eas such as eq­uity, ef­fi­ciency and qual­ity. For in­stance, in­di­ca­tors of ef­fi­ciency in­clude rates of du­pli­cate med­i­cal tests and pre­ventable hos­pi­tal read­mis­sions.

Eighty-one mil­lion adults were with­out in­sur­ance or un­der­in­sured at some point in 2010—a steep jump from 61 mil­lion in 2003, ac­cord­ing to the re­port. Also, only 4% of adults live in states where av­er­age in­sur­ance pre­mi­ums are less than 15% of house­hold in­come.

Dur­ing an event mark­ing the re­lease of the re­port, Dr. David Blu­men­thal ex­pressed dis­may that be­ing unin­sured or un­der­in­sured was quickly be­com­ing the norm. Blu­men­thal chairs the Com­mon­wealth Fund’s 17-mem­ber Com­mis­sion on a High Per­for­mance Health Sys­tem, which au­thored the re­port. He also is a fac­ulty mem­ber at Har­vard Med­i­cal School, Bos­ton, and from April 2009 to April 2011 was HHS’ national co­or­di­na­tor for health­care in­for­ma­tion tech­nol­ogy. “There is an enor­mous amount of work to do,” Blu­men­thal said. The news wasn’t all bad, how­ever. The score­card re­port noted big gains in some ar­eas of clin­i­cal qual­ity, cred­ited largely to pub­lic-reporting ef­forts and other per­for­man­ceim­prove­ment ini­tia­tives. The per­cent­age of adults whose high blood

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