U.S. health care lagging behind other countries

There's lots of room for the U.S. health care system to improve on measures of health outcomes, quality, access, efficiency and equity, according to a national scorecard the Commonwealth Fund released last month.

The first annual scorecard examined how the United States' national average compared with the top 10% of industrialized nations, as well as states, hospitals and insurance plans here at home. Researchers looked at 37 indicators and found the United States scored 66 on a 100-point scale. The study also breaks down how the nation fares on the following five dimensions on the same 100 scale:

• Quality: 71
• Equity: 71
• Long, healthy and productive lives: 69
• Access: 67
• Efficiency: 51

Catherine Schoen, the lead researcher on the scorecard project, said the United States should be doing better considering that its system costs twice as much as that of other industrialized countries.

Areas where the U.S. national average falls short of the top performers include infant mortality, control of adult diabetics' hemoglobin A1c levels and the number of adults insured all year.

"These gaps cut across all core domains of performance," Schoen said, estimating that if the system could hit the study's benchmark rates it would save as many as 150,000 lives a year and save $100 billion in direct health costs.

James J. Mongan, MD, CEO of Boston's Partners HealthCare System Inc. and chair of the Commonwealth Fund's Commission on a High Performance Health System, said the scorecard draws attention to the tremendous variation in care available in the United States.

"Undeniably, some of the best health care in the world exists in this country," Dr. Mongan said. "We see world leaders flying here for health care, not elsewhere.

"You can run, but you can't hide from this mass of statistics that, taken as whole, say we fall far short of having the best health care system. It's a very important distinction."

Dr. Mongan said larger, more coordinated care, expanded information technology, and a guarantee of affordable health insurance coverage are keys to improving the nation's grade on the scorecard.

Grace-Marie Turner, president of the Galen Institute, a nonprofit health policy research organization, said the study is misleading because international comparisons are bedeviled by varying standards. For example, the definition of infant mortality varies around the world.

"You really do need to make sure you're operating off the same platform and indeed comparing apples to apples," Turner said.

Schoen acknowledged that difficulty, but said the study accounted for it by also comparing the U.S. national average with top-performing domestic hospitals and health plans.