U.S. health system performance: A national scorecard

Health Affairs

Volumn 25, Issue 6, 2006, Pages

  Schoen, Cathy ^a   Davis, Karen ^a   How, Sabrina K H ^b   Schoenbaum, Stephen C ^b  

^a Commonwealth Fund ^*  (United States)

^b NONE

Author keywords

[No Author keywords available]

Indexed keywords

ARTICLE; COMPARATIVE STUDY; HEALTH CARE DELIVERY; HEALTH CARE POLICY; HEALTH CARE QUALITY; HEALTH SERVICES RESEARCH; HUMAN; INTERNATIONAL COOPERATION; ORGANIZATION AND MANAGEMENT; OUTCOME ASSESSMENT; PATIENT CARE; QUALITY CONTROL; REIMBURSEMENT; SOCIAL BEHAVIOR; SOCIAL JUSTICE; UNITED STATES;

BENCHMARKING; CONTINUITY OF PATIENT CARE; EFFICIENCY, ORGANIZATIONAL; HEALTH POLICY; HEALTH SERVICES ACCESSIBILITY; HEALTH SERVICES RESEARCH; HUMANS; INTERNATIONALITY; OUTCOME ASSESSMENT (HEALTH CARE); QUALITY INDICATORS, HEALTH CARE; REIMBURSEMENT MECHANISMS; SOCIAL JUSTICE; SOCIAL RESPONSIBILITY; UNITED STATES;

EID: 33845286511     PISSN: 02782715     EISSN: 02782715     Source Type: Journal    
DOI: 10.1377/hlthaff.25.w457     Document Type: Article

References (33)

1. G.F. Anderson et al., "Health Care Spending and Use of Information Technology in OECD Countries," Health Affairs 25, no. 3 (2006): 819-831.
2. P. Fronstin, Workers' Health Insurance: Trends, Issues, and Options to Expand Coverage, March 2006, http://www.cmwf.org/usr_doc/ Fronstin_workershltins_908.pdf (accessed 13 September 2006).
3. P.S. Hussey et al., "How Does the Quality of Care Compare in Five Countries?" Health Affairs 23, no. 3 (2004): 89-99.
4. Institute of Medicine, Crossing the Quality Chasm: A New Health System for the Twenty-first Century (Washington: National Academies Press, 2001).
5. Medicare Payment Advisory Commission, "Care Coordination," Chap. 2 in Report to the Congress: Increasing the Value of Medicare (Washington: MedPAC, June 2006), 31-56.
6. An online technical appendix lists experts contributing to the scorecard, details data sources, and describes indicators and composites developed for the scorecard. Throughout the discussion of the scorecard results in the text,many factual statements aremade that are not directly attributed to specific sources using traditional endnotes, because of space constraints. Unless otherwise specified, sources for these statements are included in the indicator source notes for each exhibit. The appendix is available online at http://content. healthaffairs.org/cgi/content/full/hlthaff.25.w457/DC2.
7. A chartpack is available from the Commonwealth Fund at http://www.cmwf.org/publications/publications_show.htm?doc_id=401577.
8. Indicators with 100 percent targets include adults with adequate coverage, adults with no medical bills/debt, families spending no more than 10 percent of income on out-of-pocket medical costs and premiums, and population under age sixty-five in states where premiums are less than 15 percent of median household income.
9. Indicator includes seven key preventive care services: blood pressure check, cholesterol screening, pap smear, mammogram, fecal occult blood test or sigmoidoscopy/colonoscopy, and flu shot. See Note 6 for online technical appendix, p. 11.
10. E.A. McGlynn et al., "The Quality of Health Care Delivered to Adults in the United States," New England Journal of Medicine 348, no. 26 (2003): 2635-2645.
11. For the list of ten hospital clinical indicators, see the online technical appendix (Note 6), p. 11.
12. MedPAC, A Data Book: Health Care Spending and the Medicare Program (Washington: MedPAC, 2005).
13. R.M. Wachter, "The End of the Beginning: Patient Safety Five Years after 'To Err Is Human'," Health Affairs 23 (2004): w534-w545 (published online 30 November 2004; 10.1377/hlthaff.w4.534).
14. B. Jarman et al., "Monitoring Changes in Hospital Standardised Mortality Ratios," British Medical Journal 330, no. 7487 (2005): 329;
15. and Institute for Healthcare Improvement, Move Your Dot: Measuring, Evaluating, and Reducing Hospital Mortality Rates (Cambridge, Mass.: IHI, 2003).
16. Data analysis by Sir Brian Jarman, Imperial College, England. Jarman calculated ratios and potential reductions in mortality. See online technical appendix (Note 6), pp. 12-13.
17. For hospitals providing 2005 data to HCAHPS benchmarking database. Data analysis provided by AHRQ.
18. IOM, Hidden Costs, Value Lost: Uninsurance in America (Washington: National Academies Press, 2003).
19. S.R. Collins et al., Gaps in Health Insurance: An All-American Problem, April 2006, http://www.cmwf.org/usr_doc/Collins_gapshltins_920.pdf (accessed 12 September 2006).
20. S.R. Collins et al., Gaps in Health Insurance: An All-American Problem, 2006, http://www.cmwf.org/usr_doc/Collins_gapshltins_920.pdf Ibid.;
21. and M. Merlis, D. Gould, and B. Mahato, Rising Out-of-Pocket Spending for Medical Care: A Growing Strain on Family Budgets, February 2006, http://www.cmwf.org/usr_doc/Merlis_risingoopspending_887.pdf (accessed 13 September 2006).
22. Calculations by authors based on national costs are from D.T. Kruzikas et al., Preventable Hospitalizations: A Window into Primary and Preventive Care (Rockville, Md.: AHRQ, 2004). Costs inflated to 2006.
23. Calculation by authors based on 2003 variations in Medicare ACS rates and reimbursement per discharge.
24. Data analysis by Gerard Anderson, Johns Hopkins University. See online technical appendix (Note 6), p. 15.
25. Calculation by authors based on 2003 variations in Medicare readmission rates and costs per readmission.
26. Data analysis by Elliott Fisher, Dartmouth Medical School. See online technical appendix (Note 6), p. 16; and E. Fisher, "Improving the Efficiency of U.S. Healthcare: Can Pay-for-Performance Help?" (Presentation at the Thirteenth Princeton Conference: Reinventing Health Care Delivery in the Twenty-first Century, 25 May 2006).
27. See also E.S. Fisher et al., "Variations in the Longitudinal Efficiency of Academic Medical Centers," Health Affairs 23 (2004): VAR19-VAR32 (published online 7 October 2004; 10.1377/hlthaff.VAR.19).
28. Organization for Economic Cooperation and Development, OECD Health Data 2005: Statistics and Indicators for Thirty Countries, CD Database, Version 10/12/2005 (Paris: OECD, 2005).
29. C.W. Burt, E. Hing, and D. Woodhall, "Electronic Medical Record Use by Office-based Physicians: United States, 2005," 3August 2006, http://www.cdc.gov/nchs/products/pubs/pubd/hestats/electronic/electronic.htm (accessed 29 August 2006).
30. American Hospital Association, Forward Momentum: Hospital Use of Information Technology (Chicago: AHA, 2005).
31. A.M. Audet et al., "Measure, Learn, and Improve: Physicians' Involvement in Quality Improvement," Health Affairs 24, no. 3 (2005): 843-853.
32. See, for example, AHRQ, National Healthcare Disparities Report, 2005 (Rockville, Md.: AHRQ, 2005).
33. Coalition for Health Services Research, "Unlocking Secrets to Better Health Care," Testimony before the House Committee on Appropriations, 29 March 2006, http://www.chsr.org/testimony032906.pdf (accessed 29 August 2006).