The U.S. healthcare system is faltering in areas such as affordability and access, according to a report from the Commonwealth Fund's Commission on a High Performance Health System. In its third annual report, Why Not the Best? Results from the National Scorecard on U.S. Health System Performance, 2011, the commission gave the nation's healthcare system a grade of 64 out of a possible 100.

By 2010, 81 million adults were uninsured or underinsured at some point during the last year, according to the report. High rates of preventable hospital readmissions and high administrative costs contributed to a low score—53 out of 100—on an overall measure of health system efficiency.

But the scorecard also pointed to the success of public reporting initiatives, which have improved quality in areas such as surgical care, hypertension and heart failure care, the commission said.

“This scorecard illustrates that focused efforts to change the healthcare system for the better are working and are worth the investment,” said Maureen Bisognano, a member of the commission and president and CEO of the Boston-based Institute for Healthcare Improvement.

The authors also expressed optimism that the provisions of the health reform law would address many of the problems highlighted in the report.

“If we target areas where we fall short and learn from high-performing innovators with the United States, we should see significant progress in the future,” said Dr. David Blumenthal, commission chair and professor of medicine and healthcare policy at Massachusetts General Hospital, Boston, and Harvard Medical School.