Why Not the Best?
Results from the National Scorecard on U.S. Health System Performance, 2011
“There have been encouraging improvements on several key performance indicators, as well as a number of instances where performance declined or failed to keep pace with the performance of leading nations, delivery systems, states, or regions.
The 2011 Scorecard finds that the U.S. as a whole scores only 64, compared with 67 in 2006 and 65 in 2008—well below the benchmarks. Average scores on each of the five dimensions of performance range from a low of 53 for efficiency to a high of 75 for quality of care.
Indicators That Show Promising Improvements
Information systems. The proportion of primary care physician practices that use electronic medical record (EMR) systems increased from 17% to 46% from 2000 to 2009. Still, the U.S. lags far behind the leading countries, where nearly all physicians now use EMRs.
Care for chronic conditions. Control of high blood pressure improved from 31% in 1999–2000 to 50% in 2007–2008 among national samples of adults with hypertension, a likely result of stepped- up awareness campaigns and preventive treatment targeting heart disease
and stroke. The best-performing health plans attained 75%.
Effective hospital care. Hospitals provided proven treatments to prevent surgical complications 96% of the time in 2009, an increase from 71% in 2004. Adherence to treatment standards for heart attack, heart failure, and pneumonia rose from 84% to 96%.
Preventable hospitalizations. Admission rates for heart failure and pediatric asthma each dropped by 13% from 2004 to 2007, a possible reflection of improved disease management. But rates continued to vary twofold to fourfold across hospital referral regions and states.
Preventable mortality. The rate of mortality amenable to health care—deaths that might have been prevented
with timely and effective care—improved 21% in the U.S. between 1997–98 and 2006–07. However, rates improved by 32%, on average, in 15 other industrialized nations.
Indicators That Show Significant Deterioration or No Improvement
Insurance and access. As of 2010, 81 million adults—representing 44% of all working-age adults were either uninsured sometime during the year or underinsured, meaning they were insured all year but had medical bills or deductibles that were high relative to their incomes. This represents a 33% increase from 2003, when the total was 61 million.
Affordable care. As insurance premiums rose faster than wages, the share of working-age adults living in a state where group health insurance premiums averaged less than 15% of household income dropped from 57% in 2003 to just 4% in 2009.
Primary and preventive care. In 2008, 44% of non-elderly adults lacked a regular primary care provider. The vaccination rate for young children recovered in 2010 following a sharp decline caused by a vaccine shortage in 2009, yet one-quarter of children still lacked full protection against communicable diseases.
Rehospitalizations. Average rates of hospital readmissions within 30 days of discharge for selected conditions or procedures remained high—20% of discharged
Medicare patients in both 2003 and 2009. Rates in the highest-rate regions were 50% higher than those in the
lowest-rate regions. The Affordable Care Act will provide incentives for lowering readmission rates.
Medical Benefits—1/15/2012

