The report, from the Commonwealth Fund, analysed access to care, quality of care and health outcomes in 37 countries. There was improvement in some areas since the previous rating two years ago, but countries other than the US had improved far more quickly.
Cathy Schoen, a senior author of the report, said that the overall US score had fallen from 67 to 65, on a scale of 100, over the past two years. Although modest improvements were shown in efficiency and equity, these were offset by falls in quality and in healthy lives, a measure that is based on preventable mortality and limitations in patients' activity.
Access to care was the single most important factor contributing to the US's decline, a result of rising numbers of uninsured and underinsured people - moving up into the middle class. And this, according to Cathy Schoen, a senior author, says was before the economic downturn.
If the US attained the same performance indicators achieved in other industrialised countries, Schoen added, "we could save at least 100 000 lives per year and at least $100bn."
The report tied much of the problem to a weak base of primary care doctors. Patients do not have easy access to them, it said, and their numbers are too small and are projected to shrink, with looming retirements. It also said that the healthcare system is fragmented, with insufficient tools such as electronic medical records for primary care doctors to coordinate and manage care where specialists are needed.
Low rates of reimbursement from the Medicare programme contribute to the problems of access to care and continuity of care after discharge from the hospital, resulting in a rate of readmission to hospital within 30 days of discharge that is 50% higher than in other countries for similar procedures.
Why not the best? Results from the national scorecard on US health system performance, 2008 is available at www.commonwealthfund.org
