This article first appeared in the St. Louis Beacon, Oct. 19, 2011 - The U.S. health-care system has improved, but it continues to fall short in reducing avoidable deaths, curbing health-insurance waste and cutting preventable hospital admissions, according to a "scorecard" issued Tuesday by the Commonwealth Fund at a conference in Washington, D.C.
It gave the U.S. system a grade of 64 out of 100, citing escalating costs, deteriorating access, persistent disparities and poor health outcomes. In addition to measuring quality on the basis of best-care practices within this country, the report graded the U.S. health-care system in relation to other industrial nations. Health care should be a lot better in a nation that's moving toward spending $1 of every $5 of national income on health care, the report said.
"Average U.S. health system performance would have to improve by 40 percent or more to reach the benchmark levels of performance attained by leading nations, states, regions, health plans and care providers," the report says. It did not name any American states, regions, health plans or providers used in compiling the report. The Commonwealth Fund is a private foundation that tries to improve health-care access, quality and efficiency.
The scorecard makes these points:
- The United States lags in avoiding preventable deaths. Its rate is 96 deaths for every 100,000 persons, compared to 55 in France, 57 in Australia and 60 in Italy. The study says the U.S. would have 84,000 fewer people dying prematurely by achieving the lower mortality rates of these three leading countries.
- At least 7 percent of national health expenditures is used for insurance administration, compared to 1.9 percent in Japan, 2.1 percent in France, 3.6 percent in Australia and 3.9 percent in Austria. "Reducing health-insurance administrative costs to the levels of the best-performing countries would save an estimated $114 billion a year," the report says.
- About 51 percent of adults receive recommended screening and preventive care. Raising that to a benchmark of 80 percent would improve health and cut health-care costs for an additional 66 million more adults, according to the report.
- Medicare programs could save more than $4.2 billion a year by reducing hospitalizations for preventable conditions. More hospitals are trying to improve on avoidable hospitalizations. When the Affordable Care Act is fully implemented in 2014, the federal government can reduce hospital Medicare reimbursements by 1 percent when patients have to be readmitted for the same condition within 30 days of discharge.
The report added that many gaps in performance are targeted in the Affordable Care Act and in the economic stimulus program. It said the reform law was driving some quality improvements, such as strengthening primary care, reducing high rates of readmissions and supporting health organizations that provide better care and better outcomes at lower cost.
The scorecard adds that reform legislation is projected to cut health-care spending by $590 billion over 10 years and lower premiums by nearly $2,000 for each family. But there is no certainty that the law will be implemented in its present form or at all. Concerns about costs have led the Obama administration to drop the long-term care insurance program that was part of the health-reform law. In addition, many states have joined lawsuits to try to amend or kill the reform law. The U.S. Supreme Court has yet to rule on the legal challenges.
Funding for the Beacon's health reporting is provided in part by the Missouri Foundation for Health, a philanthropic organization that aims to improve the health of the people in the communities it serves.
