Analysis: US healthcare earns sorry score


WASHINGTON, Sept. 20 (UPI) -- The U.S. health system has earned a dismal score in the most comprehensive grading of access, quality, cost, and efficiency to date.

The Commonwealth Fund, a non-partisan health policy Washington think tank, rated U.S. healthcare with a mark of 66 out of 100 when compared to the best-performing nations or states in more than three dozen measures of efficiency, access, and quality.


"I like to think of this scorecard as the diagnosis," said James Mongan, chair of the group's Commission on a High Performance Health System. "To me...the message is clear. We can do much better and we need to do much better."

Countless reports have detailed how the United States lags behind other nations -- some industrialized, and some not-so-industrialized -- in bellwether statistics like infant mortality and overall life expectancy. But its not for lack of money. The U.S. spends far more of its economy on health care than any other nation, but has less and less to show for it.


The U.S. now spends over $6,000 per capita on medical care, compared to $2,000 to $3,000 spent by the U.K., Germany, Canada, and France. But a massive lack of efficiency and equity lead to rampant waste that squanders resources that could be spent improving health, the commission's report suggests.

More than 60 million U.S. adults, lack adequate health insurance, forcing them to seek more expensive care in hospital emergency rooms and other places. Meanwhile, the U.S spends more than three times what France does administering health insurance, as a percentage of overall medical outlays.

The report stresses that the United States is not without quality and efficient care. For example, the nation's best hospitals discharge 90 percent of heart attack patients with written educational materials with advice on how to avoid another attack. Meanwhile, the national average is only 50 percent.

"The challenge, I think, is spread. It's a very fragmented system," said Maureen Bisognano, a member of the commission and executive vice president of the Institute for Healthcare Improvement, a New York-based policy group.

The commission urged U.S. policymakers to take broad steps to guarantee universal access to health insurance. But that goal has proven politically hazardous, most recently in 1994 when the White House tried and failed to execute broad health insurance reforms led by Sen. Hillary Rodham Clinton (D-N.Y.), then the First Lady.


Ever since, lawmakers have shied from comprehensive reforms in favor of smaller, incremental steps.

Medicare is beginning to use financial incentives to convince hospitals, nursing homes, and others to report quality information to the public. The government is slowly shepherding the development of electronic medical records that are already widely used in many European countries, another of the commission's recommendations.

But experts warned that overall, reforms are moving too slowly to keep up with a rapidly aging U.S. population.

"The security of a healthy nation is at stake. Actions are urgently needed," said Cathy Schoen, the commission's research director.

Many U.S. lawmakers are still fond of defending the United States' health care system as the best in the world. Asked if such claims should now be ignored, Mongan suggested that they should be seriously questioned.

"You can run, but you can't hide from this mass of statistics...that taken as a whole, we fall far short," he said.

Health policy experts identified a number of troublespots in the current U.S. healthcare system where duplication and waste are driving up costs.

Schoen said a major culprit in the high cost of healthcare is the perpetual "churning" of patients in and out of hospitals with critical information on their drug regimens and medical histories lost in the process. "We need better transitional care to make sure a patient discharged from a hospital knows what follow-up symptoms to look for," Schoen told United Press International, and to ensure that care facilities to which a patient is handed over after hospital discharge knows the patient's history.


Without this information as the patient moves through multiple specialists and facilities, "MRI scans are ordered that aren't necessary and there are more drug interactions because the providers don't know what other drugs the patient is taking," she said.

IHI's Bisognano agreed that hospital discharge is major point of vulnerability in the present system. "We have great (healthcare) organizations, but patients fall through the cracks between them," she told UPI. As a patient moves from the hospital to the home setting, "there is little follow-up in most cases," she said.

So a patient with multiple conditions might have five or six different specialists, and it is up to the patient to inform each of those doctors of a change in his medication, for example. "There is an endless cycle of the patient having the burden of communication because we have no system," she said. Bisognano told UPI that some regions like Washington state have tried to tackle the problem via "shared care" programs, where the patient takes a single, standardized form with drug information and other data from specialist to specialist.

Schoen noted that the Commonwealth Fund survey revealed wide variations among U.S. regions in the Midwest and Northeast in terms of healthcare cost and quality. She told UPI that the areas scoring highest in both areas were regions with a "strong primary care orientation" and less emphasis on multiple specialists, which in turn have less likelihood of medical error and hospital readmissions.


Alan Sagar, co-director of the health reform program at Boston University's School of Public Health, agreed that reinvigorating the primary-care sector of medicine is key to cutting healthcare costs and upping quality. In addition to paying primary care physicians more and training additional doctors, "We should make sure everyone has a physician they can reach by phone and who they can see that day," he said.

But beyond the practitioners, Schoen said health insurers should do their part to reduce administrative costs and unnecessary paperwork. Private plans and Medicare should standardize their claim forms for example, so that "one form could be reported out to multiple payers," she said. "We can't have everyone paying doctors differently. They're busy taking care of patients; they need a rational system."

Sagar agreed. "We should eliminate the paperwork that now tortures doctors. (Presently),they juggle 80 different formularies," he said.

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