Amid recent reports that life expectancy is falling in some parts of the
nation for the first time in decades, new research concludes that overall the
U.S. health care system fell short of benchmarks set in a similar report two
years earlier.
The "National Scorecard on U.S. Health System Performance,
2008," a compilation of health care statistics mostly from 2007, was
published by the Commonwealth Fund, a nonpartisan, health-focused think tank.
The scorecard aims to provide a comprehensive measure of U.S. health outcomes,
quality, access, efficiency, and equity.
Compared with the findings of the first report, released in 2006, findings
in the current report indicated worsening scores in the ability of the U.S.
health system to provide healthy lives, quality care, or access to care. The
scores for efficiency and equity improved slightly.
"The scorecard makes a compelling case for change" in health
care policy, said Cathy Schoen, senior vice president of the Commonwealth
Fund.
Among the greatest concerns was that access to care had significantly
declined, as shown in the finding that more than 75 million adults—42
percent of all adults aged 19 to 64—were underinsured or uninsured in
2007. That was an increase from 35 percent of adults in that age range in
2003.
One impact of the health insurance disparities was on quality of life:
there was a greater percentage of uninsured working-age adults who were
limited in activities because of "physical, mental, or emotional
problems," compared with insured adults.
The report also stated that the U.S. system had failed to keep pace with
the health gains in other advanced countries. The U.S. ranking fell from 15 to
19 in "mortality amenable to medical care" among the 19 countries
tracked in the report.
Among the health care areas in which the report identified a need for
improvement is access to quality mental health care. The report noted that
among adults who have major depressive illness, for example, many remain
untreated. Although the rate of treatment for people who have depression
improved from 65 percent to 69 percent on the current scorecard, that still
left nearly 1 in 3 such individuals without any care.
The researchers found that the percentage of adults who received care for a
major depressive episode was greatest among Medicare, military, and veterans
health beneficiaries—87 percent—and lowest among the
uninsured—50 percent. The researchers found as well that about 71
percent of people with private insurance who needed depression treatment
received it, as did 80 percent of Medicaid beneficiaries.
"Mental health indicators tell us this is an area where we need to
improve in the United States," Schoen told Psychiatric
News.
The scorecard noted that additional gaps in mental health care are created
by the provision of inadequate mental health care, which the report defined as
care that is not effective, well-coordinated, safe, timely, and patient
centered. Improvements in mental health care would benefit not only those with
mental illness but overall society as well. Improving depression care alone
would increase workplace productivity by an estimated $2.2 billion annually,
the researchers estimated.FIG1
Schoen said that health care research consistently indicates a reliance on
crisis care to treat serious mental illness. After the crisis is resolved,
patients are frequently discharged with no follow-up care. This leaves
providers and patients "waiting for another crisis," Schoen
said.
The U.S. system could benefit from a move away from crisis mental health
management and toward systematic preventative care, which is much more
prevalent in other advanced countries.
For children's health, U.S. primary care providers tend to focus almost
exclusively on children's physical health and ignore mental health problems
that often have a serious impact on their overall health, according to the
report.
Only 59 percent of children who needed mental health care received it in
2003, the last year for which data were available, the researchers found. The
rate of treatment for mental illness ranged from 63 percent for children with
any type of health insurance to only 34 percent for children not covered by
insurance.
The scorecard is the latest research to highlight the need for changes to
improve health care outcomes for Americans, said Carolyn Clancy, director of
the federal Agency for Healthcare Research and Quality, during discussion in
July before congressional staff regarding the scorecard. The findings
illustrate that the biggest potential for savings can come from better care of
chronic conditions, for example, in the 20 percent of Medicare beneficiaries
who incur 72 percent of the program's treatment costs.
In the short term, however, "under the current financing system all
of the players lose money [if chronic care were to be improved], so there is
no incentive for change," Clancy said.
The scorecard's authors called for "bold leadership and
commitment" to pursue a whole-system approach that would improve access,
quality, and efficiency simultaneously. The specific steps to improving care
would include a universal and well-designed coverage plan that would allow
affordable access and continuity of care with low administrative expenses.
Such a system would need to be organized around the patient and not around
providers or insurers, as is the case in the current system.
"To secure a healthy nation, we need to come together around plans
and policies that can improve health outcomes," Schoen emphasized.
The "National Scorecard on U.S. Health System Performance,
2008" is posted at<www.commonwealthfund.org/publications/publications_show.htm?doc_id=692682>.▪