The nation's costly healthcare system is a little like a vintage sports car with some serious mechanical problems: Those expensive parts work fine at times, but there's a lot about the chassis and engine that needs tinkering, a new report from a panel of influential industry leaders concludes.
In a gloomy assessment of healthcare in the U.S., the Commonwealth Fund Commission on a High Performance Health System concludes that the $2 trillion-a-year system, jammed with high-tech gadgets and precious new technology, delivers some of the best medical care in the world but still falls far short of providing "high-quality, safe, well-coordinated and efficient care."
The 18-member commission says the vaunted health system is "rife with inefficiencies," leaving tens of millions without healthcare coverage and creating an environment filled with disparities and inequality. Among the reasons: a pervasive lack of accountability, inadequate funding for information technology and an upside-down payment system that rewards inefficiency.
"We're not doing well," declared Karen Davis, president of the New York-based Commonwealth Fund, which established the commission in July 2005. "And we're not moving in the right direction to fix it. The basic fact is that we spend more than any other country on healthcare -- more than twice the amount of any other country -- and yet we fail to guarantee access to 46 million people. Both of those numbers are getting worse. It makes you realize we need to wake up and do something about it."
Commission Chairman James Mongan, a physician who is president and chief executive officer of Partners HealthCare System in Boston, said the clear message of the report is that "our future health and economic well-being depends on acting now" to improve the quality of medical care in this country.
"Some of the best medicine in the world clearly takes place here," he said. "But when looked at across the system, there are lots of areas for improvement."
The commission, which includes physicians, hospital administrators, insurers, employers, consumer advocates and government officials, said the vital first step toward improvement is establishing better-organized systems of care. Only then, the report said, will doctors and hospitals be able to implement the best evidence-based medicine, expand the use of IT, reward efficient care through pay-for-performance programs, increase health coverage and boost public reporting on quality and costs.
"I think there's a major challenge in terms of all the progress that needs to be made," Mongan said. "But I think we're optimistic that the tools and the methods are available to move us forward."
The commission, whose general recommendations for improving the healthcare system are similar to the broad outline for change proposed by other groups and policy experts in recent years, plans to follow up the 20-page report it released last week with an annual "national scorecard" on the U.S. healthcare system, officials said. The scorecard, scheduled to be unveiled Sept. 20, will attempt to gauge the system's effectiveness in about 40 indicators, including access and affordability. Officials said it is the first national scorecard of its kind to use established benchmarks to rate the system in so many areas.
The year-old commission is one of many organizations -- public and private -- that are devoting resources to try to improve the healthcare system. But Mongan said the commission is unique because of its ambitious attempt to dissect the entire system rather than to focus on specific parts.
"To a greater extent than most groups," Mongan said, "this commission is looking at the broader landscape. It's the range of issues -- access, quality, safety, efficiency, the breadth of the mandate -- that differentiates us. And there's also the concept of the annual national scorecard. I don't know of any other commission that has set out numbers that can be tracked as opposed to issuing a report and disbanding."
Officials said they will use the commission's national scorecard as a way to help promote the overall goal of exploring ways to improve the system's performance, expand health-insurance coverage and invest in a wide range of quality improvements, including IT. In addition to its annual scorecard, the commission expects to help set "realistic" targets for a high-performance health system, recommending concrete steps to achieve goals in five-year increments.