Dishonor Roll

U.S. health system’s grade knocked down to a D.

BY ERIC WAHLGREN
The Journal Of Life Sciences

Whether it’s John or Barack, we’ll have our work cut out for us when it comes to fixing healthcare.

A new study from The Commonwealth Fund, a foundation focused on improving healthcare access, quality, and efficiency, downgrades the U.S. health system to a score of 65 out of 100. That compares to a 67 in 2006. At the public high school I attended at least, such results would be akin to slipping from a “D+” to “D” student—not exactly the kind of performance we want from the odd medical conglomerate we’ve built over the years to keep us alive and healthy.

The study compares national averages in five dimensions—healthcare outcomes, quality, access, efficiency, and equity—with U.S. and international performance benchmarks. Of greatest concern, says The Commonwealth Fund, is that access to health care has “significantly declined” in the last few years. As of 2007, some 42 percent of American adults (75 million adults) were either uninsured or underinsured during the year, up from 35 percent in 2003. “Overall, [the study] finds the U.S. is losing ground in providing access to care and has uneven healthcare quality,” group says.

Indeed, the report really makes the system out to be a real loser. The U.S. now is last out of 19 countries, after France, Japan, Ireland, and Portugal, among others, in terms of mortality that could be prevented through timely and effective healthcare. Two years ago, it was 15 on the list. That’s of course despite the fact that the U.S. is the world’s drunken sailor when it comes to healthcare spending, forking out twice per capita what other major industrialized countries spend on healthcare, according to the report.

Part of the explanation for the spending paradox is that the U.S. system gets an “F” (53) for efficiency when evaluated for the number of avoidable hospitalizations, the low use of information technology, and other factors. In the U.S., patients were up to four times more likely to have duplicate tests or medical records than in other countries. “The U.S. currently under-invests in the capacity of the health system to innovate and improve,” The Commonwealth Fund says.

There are a few brighter spots. The rates of control of high blood pressure among American adults increased to 41 percent in 2003-2004 from 31 percent in 1999-2000, according to the report. Control rates for diabetes rose to 88 percent from 79 percent in the same period, the group said.

Despite all the study’s doom and gloom, the U.S. remains a remarkable place for medical talent and innovation. Even if the system as a whole is a mess, the individual institutions and medical professionals that make up the system are often the envy of the world. What the system urgently needs, The Commonwealth Fund says, is national leadership “to yield greater value for the resources devoted to healthcare.” But with a war, mortgage crisis, global warming, and creeping inflation among the other problems facing whoever is the next president, helping healthcare get its grades up will be no cinch.