(Click here for a full-sized view.)

Via Sara Kliff, the Commonwealth Fund has released its annual national score card on the U.S. health system performance. The overall score for 2011 is 64 out of a possible 100, a three point loss from last year.

Here's a graphical snapshot:

(Click here for a full-sized view.)

And the overall assessment, which isn't pretty.

U.S. health system performance continues to fall far short of what is attainable, especially given the enormity of public and private resources devoted nationally to health. Across 42 performance indicators, the U.S. achieves a total score of 64 out of a possible 100, when comparing national rates with domestic and international benchmarks. Overall, the U.S. failed to improve relative to these benchmarks, which in many cases rose. Costs were up sharply, access to care deteriorated, health system efficiency remained low, disparities persisted, and health outcomes failed to keep pace with benchmarks. The Affordable Care Act targets many of the gaps identified by the Scorecard. [...] Of great concern, access to health care significantly eroded since 2006. As of 2010, more than 81 million working-age adults—44 percent of those ages 19 to 64—were uninsured during the year or underinsured, up from 61 million (35%) in 2003. Further, the U.S. failed to keep pace with gains in health outcomes achieved by the leading countries. The U.S. ranks last out of 16 industrialized countries on a measure of mortality amenable to medical care (deaths that might have been prevented with timely and effective care), with premature death rates that are 68 percent higher than in the best-performing countries. As many as 91,000 fewer people would die prematurely if the U.S. could achieve the leading country rate. [...] Performance on indicators of health system efficiency remains especially low, with the U.S. scoring 53 out of 100 on measures that gauge the level of inappropriate, wasteful, or fragmented care; avoidable hospitalizations; variation in quality and costs; administrative costs; and use of information technology. Lowering insurance administrative costs to benchmark country rates could alone save up to $114 billion a year, or $55 billion if such costs were lowered to the level in countries with a mixed private–public insurance system, like the U.S. has. The lack of improvement on many health system indicators—such as preventive care, adults and children with strong primary care connections, and hospital readmissions—likely stems from the nation's weak primary care foundation and from inadequate care coordination and teamwork both across sites of care and between providers. These gaps highlight the need for a whole-system approach, in which performance is measured and providers are held accountable for performance across the continuum of care.

There is some good news. The lower right quadrant on that graph (click here to see it full size) shows that some regions are reducing hospital readmissions under Medicare, and thus showing significant savings. Control of high blood pressure has improved significantly since 2000 and smoking rates are still steadily declining.

Some of the gaps found in this year's study will be addressed by the Affordable Care Act, most significantly by providing access to health insurance which will in turn provide more access to care. Some of that access to care is still questionable, however, particularly if Medicaid ends up being significantly cut in ongoing deficit, debt and budget negotiations. But the ACA should also prompt and reward more effective and efficient delivery of care, which will help close more of these gaps.

