The American healthcare system is not very healthy, according to a wide-ranging new assessment of the system that covers 42 measures of healthcare delivery, the United States scored just 64 out of 100. “Costs are up sharply, access to care deteriorated, health system efficiency remains low, disparities persisted, and health outcomes fail to keep pace with benchmarks,” concluded the 2011 National Scorecard on U.S. Health System Performance. The report was issued by the Commonwealth Fund, a nonprofit healthcare policy foundation.
There are some bright spots on the report. For one, the number of Americans who are controlling their high blood pressure rose from 31 percent in 2008 to 50 percent in 2009. Additionally hospitals have improved their ability to care for patients with heart attacks, pneumonia, and other common conditions.
The Commonwealth Fund report also determined that the typical U.S. infant mortality rate is 35 percent higher than the top-performing states. Other wealthy countries still have infant mortality rates that are significantly lower than the best-performing states in the United States. If the U.S. did as well as the top-performing country in that category — France — 91,000 fewer babies would die prematurely each year, Cathy Schoen, senior vice president at Commonwealth Fund said. “These statistics are real,” she said. “They are real human lives.” Other “areas of concern” include childhood obesity, preventive care and infant mortality.
Another issue is cost, an oft-cited statistic that the U.S. spends more per person on healthcare than any other country. According to the Commonwealth Fund report, the nation in general spends twice as much as comparable countries, but doesn’t have better care to show for it. “We are headed toward spending $1 of every $5 of national income on healthcare,” the report’s authors said. “We should expect a better return on this investment.” The high cost of healthcare takes a toll on personal finances, the report said. By 2010, 40 percent of working-age adults had medical debt or difficulties paying medical bills, an increase of 34 percent when compared with 2005.
It is important to note that the majority of the report’s data is from 2007 – 2009, prior to the passage of the Patient Protection and Affordable Care Act (ACA). The healthcare reform law is likely to lead to improved scores on some of the categories, particularly access and affordability. For example, 25 percent of residents in 15 states lacked health insurance. The ACA will require that all Americans have health insurance in 2014. It also will reduce eligibility requirements for Medicaid so more low-income people will be eligible, and provide government subsidies to others who can’t buy insurance on their own.
The report’s authors remain optimistic that the health reform law will address many of the problems highlighted in the report. “This scorecard illustrates that focused efforts to change the healthcare system for the better are working and are worth the investment,” said Maureen Bisognano, president and CEO of the Boston-based Institute for Healthcare Improvement. “If we target areas where we fall short and learn from high-performing innovators with the United States, we should see significant progress in the future,” said Dr. David Blumenthal, commission chair and professor of medicine and healthcare policy at Massachusetts General Hospital and Harvard Medical School.
Writing in the Huffington Post, a Social Epidemiologist at Columbia University, thinks that the price Americans pay for their healthcare is too high. “It’s well known that Americans pay more for less when it comes to healthcare than just about any other country in the world. In 2009, we spent nearly $8,000 per person to provide medical care to just over 80 percent of our population — that compares, for example, to just under $3,500 spent per person in the U.K. to provide care for the entire population. To add injury to insult: our counterparts across the pond get an extra year of life for their $3,500 than we do for our $8,000.
“Why do we pay more for less when it comes to our health? Every policy wonk has his theory. Common ones include the high cost of American medical education (which is too expensive), or that permissive tort laws in the U.S. enable lawyers to profit from the health system (which is true). But while each of these theories, and others, explain small quirks in our health system that certainly contribute to it’s gargantuan price tag, they don’t address the fundamental issue with our health system. And that’s that our market-driven system introduces perverse financial incentives for medical providers that don’t align with the health or wellbeing of Americans. This leads to wasted money and lost lives.
“In our healthcare system, the fundamental billing unit is the “procedure” — doctors charge per action, diagnostic or curative, taken on the part of a patient. While, on the surface, rewarding doctors for each step they take to make a patient better may seem fair, it has disastrous consequences for the structure of our health system. Chief among them is our top-heavy specialty physician structure,” El-Sayed concluded.
