Jane Anderson

Access to care has declined significantly since 2003, with 42% of all working-age adults either uninsured or underinsured in 2007, according to a national health system scorecard from The Commonwealth Fund, which found that health care system performance in the United States has worsened slightly overall since 2006.

According to the scorecard report, the United States on average continues to fall far short on key indicators of health outcomes and quality. U.S. scores are particularly low on efficiency, compared with top performers inside the country—states, regions, hospitals, health plans, or other providers—and internationally.

“These findings were very disturbing, considering the resources the U.S. spends on health care,” Dr. Karen Davis, president of The Commonwealth Fund, said in a briefing on the report, adding that the nation spends more on health care than any other in the industrialized world.

In the report, “Why Not the Best? Results From the National Scorecard on U.S. Health System Performance, 2008,” the United States scored an average of 65 out of a possible 100—slightly below the 67 scored in 2006 in the first scorecard released—across 37 key indicators of health outcomes, quality, access, efficiency, and equity. “We need to change direction,” Dr. Davis said. “This latest scorecard demonstrates that we are in fact losing ground.”

The report found that the number of uninsured and underinsured Americans continues to rise: As of 2007, 42% of all working-age adults were either uninsured or underinsured—up from 35% in 2003.

The report also said that the United States failed to keep up with improvements made in other countries, and fell from 15th place to dead last among 19 industrialized nations in premature deaths that could have been prevented by timely access to effective health care. Rates for basic preventive care, such as cancer screening, failed to improve from 2005 to 2007, the report said.

In addition, “scores on efficiency are particularly low, pulled down by fragmented, poorly coordinated care,” along with lack of access to care and high administrative costs, said Cathy Schoen, senior vice president of The Commonwealth Fund.

In 2007, for example, as in 2005, patients in the United States were three to four times more likely than patients in other countries to report having had duplicate tests or to report that medical records or test results were not available at the time of their appointment. And, although primary care physicians in the United States used electronic medical records (EMRs) increasingly from 2001 to 2006—17% to 28%—the United States lags far behind leading countries, where EMRs now are used by nearly all physicians (98%) to improve care, the scorecard reported.

Still, “there are some bright spots,” Ms. Schoen said. The report found evidence that focusing on specific areas through targeted initiatives can yield substantial improvement.

For example, the report found that hospital standardized mortality ratios, a key indicator of patient safety, improved by 19% over 5 years, following broad public and private efforts to assess and improve hospital safety. Also, chronic care and acute hospital care quality metrics that have been the focus of public reporting, pay for performance, and improvement efforts also showed significant progress.

“We find that what gets attention gets improved,” Ms. Schoen said. “But to date we have focused too narrowly. Current initiatives often fail to encourage more effective or more efficient care.”

Dr. Davis pointed out that, with a new president and administration next year, the United States has a real opportunity to refocus and rebuild its health care system.

“The most important thing is extending health insurance to all,” she said. “There were 75 million American adults uninsured at some point in the year, and obviously that affects performance throughout the scorecard.”

Access to care has declined significantly since 2003, with 42% of all working-age adults either uninsured or underinsured in 2007, according to a national health system scorecard from The Commonwealth Fund, which found that health care system performance in the United States has worsened slightly overall since 2006.

According to the scorecard report, the United States on average continues to fall far short on key indicators of health outcomes and quality. U.S. scores are particularly low on efficiency, compared with top performers inside the country—states, regions, hospitals, health plans, or other providers—and internationally.

“These findings were very disturbing, considering the resources the U.S. spends on health care,” Dr. Karen Davis, president of The Commonwealth Fund, said in a briefing on the report, adding that the nation spends more on health care than any other in the industrialized world.

In the report, “Why Not the Best? Results From the National Scorecard on U.S. Health System Performance, 2008,” the United States scored an average of 65 out of a possible 100—slightly below the 67 scored in 2006 in the first scorecard released—across 37 key indicators of health outcomes, quality, access, efficiency, and equity. “We need to change direction,” Dr. Davis said. “This latest scorecard demonstrates that we are in fact losing ground.”

The report found that the number of uninsured and underinsured Americans continues to rise: As of 2007, 42% of all working-age adults were either uninsured or underinsured—up from 35% in 2003.

The report also said that the United States failed to keep up with improvements made in other countries, and fell from 15th place to dead last among 19 industrialized nations in premature deaths that could have been prevented by timely access to effective health care. Rates for basic preventive care, such as cancer screening, failed to improve from 2005 to 2007, the report said.

In addition, “scores on efficiency are particularly low, pulled down by fragmented, poorly coordinated care,” along with lack of access to care and high administrative costs, said Cathy Schoen, senior vice president of The Commonwealth Fund.

In 2007, for example, as in 2005, patients in the United States were three to four times more likely than patients in other countries to report having had duplicate tests or to report that medical records or test results were not available at the time of their appointment. And, although primary care physicians in the United States used electronic medical records (EMRs) increasingly from 2001 to 2006—17% to 28%—the United States lags far behind leading countries, where EMRs now are used by nearly all physicians (98%) to improve care, the scorecard reported.

Still, “there are some bright spots,” Ms. Schoen said. The report found evidence that focusing on specific areas through targeted initiatives can yield substantial improvement.

For example, the report found that hospital standardized mortality ratios, a key indicator of patient safety, improved by 19% over 5 years, following broad public and private efforts to assess and improve hospital safety. Also, chronic care and acute hospital care quality metrics that have been the focus of public reporting, pay for performance, and improvement efforts also showed significant progress.

“We find that what gets attention gets improved,” Ms. Schoen said. “But to date we have focused too narrowly. Current initiatives often fail to encourage more effective or more efficient care.”

Dr. Davis pointed out that, with a new president and administration next year, the United States has a real opportunity to refocus and rebuild its health care system.

“The most important thing is extending health insurance to all,” she said. “There were 75 million American adults uninsured at some point in the year, and obviously that affects performance throughout the scorecard.”

Access to care has declined significantly since 2003, with 42% of all working-age adults either uninsured or underinsured in 2007, according to a national health system scorecard from The Commonwealth Fund, which found that health care system performance in the United States has worsened slightly overall since 2006.

According to the scorecard report, the United States on average continues to fall far short on key indicators of health outcomes and quality. U.S. scores are particularly low on efficiency, compared with top performers inside the country—states, regions, hospitals, health plans, or other providers—and internationally.

“These findings were very disturbing, considering the resources the U.S. spends on health care,” Dr. Karen Davis, president of The Commonwealth Fund, said in a briefing on the report, adding that the nation spends more on health care than any other in the industrialized world.

In the report, “Why Not the Best? Results From the National Scorecard on U.S. Health System Performance, 2008,” the United States scored an average of 65 out of a possible 100—slightly below the 67 scored in 2006 in the first scorecard released—across 37 key indicators of health outcomes, quality, access, efficiency, and equity. “We need to change direction,” Dr. Davis said. “This latest scorecard demonstrates that we are in fact losing ground.”

The report found that the number of uninsured and underinsured Americans continues to rise: As of 2007, 42% of all working-age adults were either uninsured or underinsured—up from 35% in 2003.

The report also said that the United States failed to keep up with improvements made in other countries, and fell from 15th place to dead last among 19 industrialized nations in premature deaths that could have been prevented by timely access to effective health care. Rates for basic preventive care, such as cancer screening, failed to improve from 2005 to 2007, the report said.

In addition, “scores on efficiency are particularly low, pulled down by fragmented, poorly coordinated care,” along with lack of access to care and high administrative costs, said Cathy Schoen, senior vice president of The Commonwealth Fund.

In 2007, for example, as in 2005, patients in the United States were three to four times more likely than patients in other countries to report having had duplicate tests or to report that medical records or test results were not available at the time of their appointment. And, although primary care physicians in the United States used electronic medical records (EMRs) increasingly from 2001 to 2006—17% to 28%—the United States lags far behind leading countries, where EMRs now are used by nearly all physicians (98%) to improve care, the scorecard reported.

Still, “there are some bright spots,” Ms. Schoen said. The report found evidence that focusing on specific areas through targeted initiatives can yield substantial improvement.

For example, the report found that hospital standardized mortality ratios, a key indicator of patient safety, improved by 19% over 5 years, following broad public and private efforts to assess and improve hospital safety. Also, chronic care and acute hospital care quality metrics that have been the focus of public reporting, pay for performance, and improvement efforts also showed significant progress.

“We find that what gets attention gets improved,” Ms. Schoen said. “But to date we have focused too narrowly. Current initiatives often fail to encourage more effective or more efficient care.”

Dr. Davis pointed out that, with a new president and administration next year, the United States has a real opportunity to refocus and rebuild its health care system.

“The most important thing is extending health insurance to all,” she said. “There were 75 million American adults uninsured at some point in the year, and obviously that affects performance throughout the scorecard.”

Groups Urge Child Focus in Election

Thirty of the nation's child-related organizations—including the American Academy of Pediatrics, Prevent Child Abuse America, Every Child Matters, and the National Association of Social Workers—pleaded for an election-year focus by candidates and the news media on the plight of millions of at-risk children and youths. Representatives of the groups pointed out at a press briefing that since the start of the wars in Afghanistan and Iraq, 28,000 U.S. children have died because of abuse, homicide, or suicide; 1.1 million more children are living in poverty; and an additional 4.4 million families lack health insurance. “It's time for us to step up for kids,” Dr. Renee Jenkins, AAP president, said at the briefing. “We do it in our everyday lives, but we need to do it in the political arena as well. As a nation, we're sorely lacking in our commitment to children.”

Healthier Drinks Seen in Schools

The beverage industry has significantly reduced the number of high-calorie beverages available in schools, 2 years into the 3-year implementation of the national School Beverage Guidelines, according to an independent evaluation. The Alliance for a Healthier Generation, a joint initiative of the William J. Clinton Foundation and the American Heart Association, worked with major beverage manufacturers to establish guidelines that limit portion sizes and reduce the number of calories from beverages available to children during the school day. The 2007–2008 progress report showed that the total number of calories in the beverages shipped to schools decreased by 58% since 2004, and that 79% of schools in contracts with bottlers already are in compliance with the guidelines. Under the guidelines, approved beverage options include 100% juice, low-fat milk, and bottled water in elementary and middle schools. High schools can add diet sodas, calorie-capped sports drinks and enhanced waters, and low-calorie teas.

Rx Monitoring Finds Problems

One-third of drugs studied as part of a Food and Drug Administration initiative designed to spur more testing in children required labeling changes or other actions to warn of side effects or other reactions in the pediatric population, a study found. The FDA initiative, approved as part of FDA legislation in 1997, grants an additional 6 months of marketing exclusivity to drug companies that agree to conduct studies of their drugs in the pediatric population. Researchers reporting in Pediatrics found that of 67 drugs granted exclusivity under that program, the FDA's Pediatric Advisory Committee recommended labeling changes for 12 drugs, continued monitoring for 10 drugs, and production of medication guides for 9 drugs. One drug also had an update to its label changes. Several of the adverse events revealed during the study process were rare and life threatening, the researchers said.

Special Needs Dental Center Opens

In an effort to provide better access to oral health care for patients with disabilities and to train the next generation of dental practitioners to care for them, the University of Pittsburgh School of Dental Medicine has opened the Center for Patients With Special Needs. The center, which will offer services for those who are physically limited by birth defects, injury, or disease, as well as patients with intellectual and developmental disabilities, will be staffed by specialists from the departments of pediatric dentistry and anesthesiology. Specialty residents, predoctoral students, and dental-hygiene students will rotate through the center to expand the pool of future dental practitioners with skills to care for patients with special needs, according to the school.

SAMHSA Opens 5-Year Grant Program

The Substance Abuse and Mental Health Services Administration has opened Project LAUNCH (Linking Actions for Unmet Needs in Children's Health), a new grant program designed to promote the well-being of children from birth to age 8 by addressing the physical, emotional, social, and behavioral aspects of their development. More than $27 million in grant funds will be awarded to state and tribal programs over the next 5 years, according to SAMHSA, with grantees each receiving approximately $900,000 annually.

Foundation Launches Recess Project

The Robert Wood Johnson Foundation has announced an $18 million investment in recess activities to improve children's health at 650 low-income schools. The foundation will team with Sports4Kids, a national nonprofit organization ts pioneered an effective model for using play and classic games—such as kickball, four square, and tag—to transform the learning environment at elementary schools serving minority and low-income children. Sports4Kids puts trained adults on the playground to introduce the games, as well as to give kids simple tools, such as rock-paper-scissors, to avoid fights and keep the games going “An investment in bringing safe and healthy play back to school playgrounds … reaps dividends for the entire community,” said Dr. Risa Lavizzo-Mourey, president of the foundation.

Groups Urge Child Focus in Election

Thirty of the nation's child-related organizations—including the American Academy of Pediatrics, Prevent Child Abuse America, Every Child Matters, and the National Association of Social Workers—pleaded for an election-year focus by candidates and the news media on the plight of millions of at-risk children and youths. Representatives of the groups pointed out at a press briefing that since the start of the wars in Afghanistan and Iraq, 28,000 U.S. children have died because of abuse, homicide, or suicide; 1.1 million more children are living in poverty; and an additional 4.4 million families lack health insurance. “It's time for us to step up for kids,” Dr. Renee Jenkins, AAP president, said at the briefing. “We do it in our everyday lives, but we need to do it in the political arena as well. As a nation, we're sorely lacking in our commitment to children.”

Healthier Drinks Seen in Schools

The beverage industry has significantly reduced the number of high-calorie beverages available in schools, 2 years into the 3-year implementation of the national School Beverage Guidelines, according to an independent evaluation. The Alliance for a Healthier Generation, a joint initiative of the William J. Clinton Foundation and the American Heart Association, worked with major beverage manufacturers to establish guidelines that limit portion sizes and reduce the number of calories from beverages available to children during the school day. The 2007–2008 progress report showed that the total number of calories in the beverages shipped to schools decreased by 58% since 2004, and that 79% of schools in contracts with bottlers already are in compliance with the guidelines. Under the guidelines, approved beverage options include 100% juice, low-fat milk, and bottled water in elementary and middle schools. High schools can add diet sodas, calorie-capped sports drinks and enhanced waters, and low-calorie teas.

Rx Monitoring Finds Problems

One-third of drugs studied as part of a Food and Drug Administration initiative designed to spur more testing in children required labeling changes or other actions to warn of side effects or other reactions in the pediatric population, a study found. The FDA initiative, approved as part of FDA legislation in 1997, grants an additional 6 months of marketing exclusivity to drug companies that agree to conduct studies of their drugs in the pediatric population. Researchers reporting in Pediatrics found that of 67 drugs granted exclusivity under that program, the FDA's Pediatric Advisory Committee recommended labeling changes for 12 drugs, continued monitoring for 10 drugs, and production of medication guides for 9 drugs. One drug also had an update to its label changes. Several of the adverse events revealed during the study process were rare and life threatening, the researchers said.

Special Needs Dental Center Opens

In an effort to provide better access to oral health care for patients with disabilities and to train the next generation of dental practitioners to care for them, the University of Pittsburgh School of Dental Medicine has opened the Center for Patients With Special Needs. The center, which will offer services for those who are physically limited by birth defects, injury, or disease, as well as patients with intellectual and developmental disabilities, will be staffed by specialists from the departments of pediatric dentistry and anesthesiology. Specialty residents, predoctoral students, and dental-hygiene students will rotate through the center to expand the pool of future dental practitioners with skills to care for patients with special needs, according to the school.

SAMHSA Opens 5-Year Grant Program

The Substance Abuse and Mental Health Services Administration has opened Project LAUNCH (Linking Actions for Unmet Needs in Children's Health), a new grant program designed to promote the well-being of children from birth to age 8 by addressing the physical, emotional, social, and behavioral aspects of their development. More than $27 million in grant funds will be awarded to state and tribal programs over the next 5 years, according to SAMHSA, with grantees each receiving approximately $900,000 annually.

Foundation Launches Recess Project

The Robert Wood Johnson Foundation has announced an $18 million investment in recess activities to improve children's health at 650 low-income schools. The foundation will team with Sports4Kids, a national nonprofit organization ts pioneered an effective model for using play and classic games—such as kickball, four square, and tag—to transform the learning environment at elementary schools serving minority and low-income children. Sports4Kids puts trained adults on the playground to introduce the games, as well as to give kids simple tools, such as rock-paper-scissors, to avoid fights and keep the games going “An investment in bringing safe and healthy play back to school playgrounds … reaps dividends for the entire community,” said Dr. Risa Lavizzo-Mourey, president of the foundation.

Groups Urge Child Focus in Election

Thirty of the nation's child-related organizations—including the American Academy of Pediatrics, Prevent Child Abuse America, Every Child Matters, and the National Association of Social Workers—pleaded for an election-year focus by candidates and the news media on the plight of millions of at-risk children and youths. Representatives of the groups pointed out at a press briefing that since the start of the wars in Afghanistan and Iraq, 28,000 U.S. children have died because of abuse, homicide, or suicide; 1.1 million more children are living in poverty; and an additional 4.4 million families lack health insurance. “It's time for us to step up for kids,” Dr. Renee Jenkins, AAP president, said at the briefing. “We do it in our everyday lives, but we need to do it in the political arena as well. As a nation, we're sorely lacking in our commitment to children.”

Healthier Drinks Seen in Schools

The beverage industry has significantly reduced the number of high-calorie beverages available in schools, 2 years into the 3-year implementation of the national School Beverage Guidelines, according to an independent evaluation. The Alliance for a Healthier Generation, a joint initiative of the William J. Clinton Foundation and the American Heart Association, worked with major beverage manufacturers to establish guidelines that limit portion sizes and reduce the number of calories from beverages available to children during the school day. The 2007–2008 progress report showed that the total number of calories in the beverages shipped to schools decreased by 58% since 2004, and that 79% of schools in contracts with bottlers already are in compliance with the guidelines. Under the guidelines, approved beverage options include 100% juice, low-fat milk, and bottled water in elementary and middle schools. High schools can add diet sodas, calorie-capped sports drinks and enhanced waters, and low-calorie teas.

Rx Monitoring Finds Problems

One-third of drugs studied as part of a Food and Drug Administration initiative designed to spur more testing in children required labeling changes or other actions to warn of side effects or other reactions in the pediatric population, a study found. The FDA initiative, approved as part of FDA legislation in 1997, grants an additional 6 months of marketing exclusivity to drug companies that agree to conduct studies of their drugs in the pediatric population. Researchers reporting in Pediatrics found that of 67 drugs granted exclusivity under that program, the FDA's Pediatric Advisory Committee recommended labeling changes for 12 drugs, continued monitoring for 10 drugs, and production of medication guides for 9 drugs. One drug also had an update to its label changes. Several of the adverse events revealed during the study process were rare and life threatening, the researchers said.

Special Needs Dental Center Opens

In an effort to provide better access to oral health care for patients with disabilities and to train the next generation of dental practitioners to care for them, the University of Pittsburgh School of Dental Medicine has opened the Center for Patients With Special Needs. The center, which will offer services for those who are physically limited by birth defects, injury, or disease, as well as patients with intellectual and developmental disabilities, will be staffed by specialists from the departments of pediatric dentistry and anesthesiology. Specialty residents, predoctoral students, and dental-hygiene students will rotate through the center to expand the pool of future dental practitioners with skills to care for patients with special needs, according to the school.

SAMHSA Opens 5-Year Grant Program

The Substance Abuse and Mental Health Services Administration has opened Project LAUNCH (Linking Actions for Unmet Needs in Children's Health), a new grant program designed to promote the well-being of children from birth to age 8 by addressing the physical, emotional, social, and behavioral aspects of their development. More than $27 million in grant funds will be awarded to state and tribal programs over the next 5 years, according to SAMHSA, with grantees each receiving approximately $900,000 annually.

Foundation Launches Recess Project

The Robert Wood Johnson Foundation has announced an $18 million investment in recess activities to improve children's health at 650 low-income schools. The foundation will team with Sports4Kids, a national nonprofit organization ts pioneered an effective model for using play and classic games—such as kickball, four square, and tag—to transform the learning environment at elementary schools serving minority and low-income children. Sports4Kids puts trained adults on the playground to introduce the games, as well as to give kids simple tools, such as rock-paper-scissors, to avoid fights and keep the games going “An investment in bringing safe and healthy play back to school playgrounds … reaps dividends for the entire community,” said Dr. Risa Lavizzo-Mourey, president of the foundation.

Media Influences Tobacco Use

Media communications—including movies, advertising, and news—play a key role in shaping tobacco use, according to a lengthy report from the National Cancer Institute. It noted that cigarettes are among the most heavily marketed products in the United States, and that most of the cigarette industry's marketing budget is allocated to promotional activities, especially for price discounts, which accounted for 75% of the industry's $10 billion in total marketing expenditures in 2005. Depictions of cigarette smoking are pervasive in movies, occurring in three-quarters or more of contemporary box office hits, the NCI report said, adding that the weight of evidence indicates a causal relationship between exposure to depictions of smoking in movies and youth smoking initiation. The report provides the government's strongest conclusion to date on the media's powerful and causal effect on tobacco use, Dr. Cheryl Healton, president and CEO of the American Legacy Foundation, said in a statement. “This report provides the ammunition to tobacco control advocates around the world who are fighting to keep movies smoke free,” she said.

Tobacco Control Support Drops

Budgets for tobacco control programs in most states are either staying level or declining, despite increases in payments from the 1997 Tobacco Master Settlement Agreement, designed to compensate states for some of the cost of smoking-related illnesses, the American Lung Association reported. The ALA report blamed the stable or reduced budgets on the poor economy in a number of states on reduced tobacco control budgets. The passage of smoke-free air laws also has slowed down in most states, the ALA found. Only two states this year—Iowa and Nebraska—have approved legislation to strengthen existing laws. And, activity on cigarette tax increases in 2008 has been slower than in previous years, with only two states and the District of Columbia approving increases, the report said. New York's increase in the cigarette tax is the highest, at $1.25 a pack, the ALA said.

'Free' Rx Samples Expensive

Free drug samples provided to physicians by pharmaceutical companies actually could cost uninsured patients more in the long run, because those patients are prescribed brand-name drugs rather than generics, according to a study done by researchers at Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina. Physicians were three times more likely to prescribe generic medications to uninsured patients after drug samples were removed from their offices, according to the study, which looked at a large, university-affiliated internal medicine practice. After the clinic closed its drug sample closet, the percentage of prescribed generic medications rose from 12% to 40%, the researchers found. “It's true that samples can save patients money in the short run, but our study shows that they may end up paying more in the long run when they are given prescriptions for brand-name-only drugs,” Dr. David Miller, an internist and the study's lead researcher, said in a statement.

Grants to Doctors in Hurricanes

The AMA Foundation's Health Care Recovery Fund will provide grants of up to $2,500 to physicians in places that have been declared disaster areas by the Federal Emergency Management Agency, and the foundation currently is accepting donations to help physicians who have been directly affected by Hurricane Gustav, which affected Louisiana, Mississippi, and Texas. The foundation provides the grants to physicians in FEMA-declared disaster areas to help them rebuild or restore their damaged medical practices in those locations, according to the AMA.

Tools' Usefulness Limited

Although health plans are developing tools to help consumers compare price and quality information across hospitals and physicians, the tools' pervasiveness and usefulness are limited, according to a study by the Center for Studying Health System Change. The information provided as part of the tools often lacks specificity about individual providers, and its availability often is limited to enrollees in specific geographic areas, the study showed. When providing quality information, health plans generally rely on third-party sources to package publicly available information instead of using information from their own claims, the study found. “None of the health plans we interviewed believed that price and quality information is being used extensively by their enrollees today, in part, because few have incentives in their benefit structures to encourage cost comparisons,” Ann Tynan, HSC researcher and study coauthor, said in a statement.

Many Reach 'Doughnut Hole'

One in four Medicare Part D enrollees who filled prescriptions in 2007 reached the gap in coverage known as the “doughnut hole,” and most remained in the doughnut hole for the rest of the year, according to an analysis from the Kaiser Family Foundation. The analysis suggested that about 3.4 million beneficiaries—14% of all Part D enrollees—reached the coverage gap last year and paid the full cost of their prescriptions for part of 2007. Beneficiaries taking drugs for serious chronic conditions had a substantially higher risk of a gap in coverage under their Medicare drug plan, the study found. For example, 64% of enrollees taking medications for Alzheimer's disease reached the coverage gap in 2007, as did 51% of those taking oral diabetes medications and 45% of patients on antidepressants, the study found. The analysis excluded beneficiaries who receive low-income subsidies because they do not face a gap in coverage under their Medicare drug plan.

Media Influences Tobacco Use

Media communications—including movies, advertising, and news—play a key role in shaping tobacco use, according to a lengthy report from the National Cancer Institute. It noted that cigarettes are among the most heavily marketed products in the United States, and that most of the cigarette industry's marketing budget is allocated to promotional activities, especially for price discounts, which accounted for 75% of the industry's $10 billion in total marketing expenditures in 2005. Depictions of cigarette smoking are pervasive in movies, occurring in three-quarters or more of contemporary box office hits, the NCI report said, adding that the weight of evidence indicates a causal relationship between exposure to depictions of smoking in movies and youth smoking initiation. The report provides the government's strongest conclusion to date on the media's powerful and causal effect on tobacco use, Dr. Cheryl Healton, president and CEO of the American Legacy Foundation, said in a statement. “This report provides the ammunition to tobacco control advocates around the world who are fighting to keep movies smoke free,” she said.

Tobacco Control Support Drops

Budgets for tobacco control programs in most states are either staying level or declining, despite increases in payments from the 1997 Tobacco Master Settlement Agreement, designed to compensate states for some of the cost of smoking-related illnesses, the American Lung Association reported. The ALA report blamed the stable or reduced budgets on the poor economy in a number of states on reduced tobacco control budgets. The passage of smoke-free air laws also has slowed down in most states, the ALA found. Only two states this year—Iowa and Nebraska—have approved legislation to strengthen existing laws. And, activity on cigarette tax increases in 2008 has been slower than in previous years, with only two states and the District of Columbia approving increases, the report said. New York's increase in the cigarette tax is the highest, at $1.25 a pack, the ALA said.

'Free' Rx Samples Expensive

Free drug samples provided to physicians by pharmaceutical companies actually could cost uninsured patients more in the long run, because those patients are prescribed brand-name drugs rather than generics, according to a study done by researchers at Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina. Physicians were three times more likely to prescribe generic medications to uninsured patients after drug samples were removed from their offices, according to the study, which looked at a large, university-affiliated internal medicine practice. After the clinic closed its drug sample closet, the percentage of prescribed generic medications rose from 12% to 40%, the researchers found. “It's true that samples can save patients money in the short run, but our study shows that they may end up paying more in the long run when they are given prescriptions for brand-name-only drugs,” Dr. David Miller, an internist and the study's lead researcher, said in a statement.

Grants to Doctors in Hurricanes

The AMA Foundation's Health Care Recovery Fund will provide grants of up to $2,500 to physicians in places that have been declared disaster areas by the Federal Emergency Management Agency, and the foundation currently is accepting donations to help physicians who have been directly affected by Hurricane Gustav, which affected Louisiana, Mississippi, and Texas. The foundation provides the grants to physicians in FEMA-declared disaster areas to help them rebuild or restore their damaged medical practices in those locations, according to the AMA.

Tools' Usefulness Limited

Although health plans are developing tools to help consumers compare price and quality information across hospitals and physicians, the tools' pervasiveness and usefulness are limited, according to a study by the Center for Studying Health System Change. The information provided as part of the tools often lacks specificity about individual providers, and its availability often is limited to enrollees in specific geographic areas, the study showed. When providing quality information, health plans generally rely on third-party sources to package publicly available information instead of using information from their own claims, the study found. “None of the health plans we interviewed believed that price and quality information is being used extensively by their enrollees today, in part, because few have incentives in their benefit structures to encourage cost comparisons,” Ann Tynan, HSC researcher and study coauthor, said in a statement.

Many Reach 'Doughnut Hole'

One in four Medicare Part D enrollees who filled prescriptions in 2007 reached the gap in coverage known as the “doughnut hole,” and most remained in the doughnut hole for the rest of the year, according to an analysis from the Kaiser Family Foundation. The analysis suggested that about 3.4 million beneficiaries—14% of all Part D enrollees—reached the coverage gap last year and paid the full cost of their prescriptions for part of 2007. Beneficiaries taking drugs for serious chronic conditions had a substantially higher risk of a gap in coverage under their Medicare drug plan, the study found. For example, 64% of enrollees taking medications for Alzheimer's disease reached the coverage gap in 2007, as did 51% of those taking oral diabetes medications and 45% of patients on antidepressants, the study found. The analysis excluded beneficiaries who receive low-income subsidies because they do not face a gap in coverage under their Medicare drug plan.

Media Influences Tobacco Use

Media communications—including movies, advertising, and news—play a key role in shaping tobacco use, according to a lengthy report from the National Cancer Institute. It noted that cigarettes are among the most heavily marketed products in the United States, and that most of the cigarette industry's marketing budget is allocated to promotional activities, especially for price discounts, which accounted for 75% of the industry's $10 billion in total marketing expenditures in 2005. Depictions of cigarette smoking are pervasive in movies, occurring in three-quarters or more of contemporary box office hits, the NCI report said, adding that the weight of evidence indicates a causal relationship between exposure to depictions of smoking in movies and youth smoking initiation. The report provides the government's strongest conclusion to date on the media's powerful and causal effect on tobacco use, Dr. Cheryl Healton, president and CEO of the American Legacy Foundation, said in a statement. “This report provides the ammunition to tobacco control advocates around the world who are fighting to keep movies smoke free,” she said.

Tobacco Control Support Drops

Budgets for tobacco control programs in most states are either staying level or declining, despite increases in payments from the 1997 Tobacco Master Settlement Agreement, designed to compensate states for some of the cost of smoking-related illnesses, the American Lung Association reported. The ALA report blamed the stable or reduced budgets on the poor economy in a number of states on reduced tobacco control budgets. The passage of smoke-free air laws also has slowed down in most states, the ALA found. Only two states this year—Iowa and Nebraska—have approved legislation to strengthen existing laws. And, activity on cigarette tax increases in 2008 has been slower than in previous years, with only two states and the District of Columbia approving increases, the report said. New York's increase in the cigarette tax is the highest, at $1.25 a pack, the ALA said.

'Free' Rx Samples Expensive

Free drug samples provided to physicians by pharmaceutical companies actually could cost uninsured patients more in the long run, because those patients are prescribed brand-name drugs rather than generics, according to a study done by researchers at Wake Forest University Baptist Medical Center, Winston-Salem, North Carolina. Physicians were three times more likely to prescribe generic medications to uninsured patients after drug samples were removed from their offices, according to the study, which looked at a large, university-affiliated internal medicine practice. After the clinic closed its drug sample closet, the percentage of prescribed generic medications rose from 12% to 40%, the researchers found. “It's true that samples can save patients money in the short run, but our study shows that they may end up paying more in the long run when they are given prescriptions for brand-name-only drugs,” Dr. David Miller, an internist and the study's lead researcher, said in a statement.

Grants to Doctors in Hurricanes

The AMA Foundation's Health Care Recovery Fund will provide grants of up to $2,500 to physicians in places that have been declared disaster areas by the Federal Emergency Management Agency, and the foundation currently is accepting donations to help physicians who have been directly affected by Hurricane Gustav, which affected Louisiana, Mississippi, and Texas. The foundation provides the grants to physicians in FEMA-declared disaster areas to help them rebuild or restore their damaged medical practices in those locations, according to the AMA.

Tools' Usefulness Limited

Although health plans are developing tools to help consumers compare price and quality information across hospitals and physicians, the tools' pervasiveness and usefulness are limited, according to a study by the Center for Studying Health System Change. The information provided as part of the tools often lacks specificity about individual providers, and its availability often is limited to enrollees in specific geographic areas, the study showed. When providing quality information, health plans generally rely on third-party sources to package publicly available information instead of using information from their own claims, the study found. “None of the health plans we interviewed believed that price and quality information is being used extensively by their enrollees today, in part, because few have incentives in their benefit structures to encourage cost comparisons,” Ann Tynan, HSC researcher and study coauthor, said in a statement.

Many Reach 'Doughnut Hole'

One in four Medicare Part D enrollees who filled prescriptions in 2007 reached the gap in coverage known as the “doughnut hole,” and most remained in the doughnut hole for the rest of the year, according to an analysis from the Kaiser Family Foundation. The analysis suggested that about 3.4 million beneficiaries—14% of all Part D enrollees—reached the coverage gap last year and paid the full cost of their prescriptions for part of 2007. Beneficiaries taking drugs for serious chronic conditions had a substantially higher risk of a gap in coverage under their Medicare drug plan, the study found. For example, 64% of enrollees taking medications for Alzheimer's disease reached the coverage gap in 2007, as did 51% of those taking oral diabetes medications and 45% of patients on antidepressants, the study found. The analysis excluded beneficiaries who receive low-income subsidies because they do not face a gap in coverage under their Medicare drug plan.

Media Influences Tobacco Use

Media communications—including movies, advertising, and news—play a key role in shaping tobacco use, according to a lengthy report from the National Cancer Institute. The report noted that cigarettes are among the most heavily marketed products in the United States, and that most of the cigarette industry's marketing budget is allocated to promotional activities, especially for price discounts, which accounted for 75% of the industry's $10 billion in total marketing expenditures in 2005. Depictions of cigarette smoking are pervasive in movies, occurring in three-quarters or more of contemporary box office hits, the NCI report said, adding that the weight of evidence indicates a causal relationship between exposure to depictions of smoking in movies and youth smoking initiation. The NCI report provides the government's strongest conclusion to date on the media's powerful and causal effect on tobacco use, Dr. Cheryl Healton, president and CEO of the American Legacy Foundation, said in a statement. “This report provides the ammunition to tobacco control advocates around the world who are fighting to keep movies smoke free,” Dr. Healton said.

Tobacco Control Support Drops

Budgets for tobacco control programs in most states are either staying level or declining, despite increases in payments from the 1997 Tobacco Master Settlement Agreement, designed to compensate states for some of the cost of smoking-related illnesses, the American Lung Association reported. The ALA report blamed the stable or reduced tobacco control budgets on the poor economy in a number of states. The passage of smoke-free air laws also has slowed down in most states, the ALA found. Only two states this year—Iowa and Nebraska—have approved legislation to strengthen existing laws. And activity on cigarette tax increases in 2008 has been slower than in previous years, with only two states and the District of Columbia approving increases, the report said. New York's increase in the cigarette tax is the highest, at $1.25 a pack, the ALA said.

Grants to Doctors in Hurricanes

The AMA Foundation's Health Care Recovery Fund will provide grants of up to $2,500 to physicians in places declared disaster areas by the Federal Emergency Management Agency, and the foundation is accepting donations to help physicians who have been directly affected by Hurricane Gustav, which hit Louisiana, Mississippi, and Texas. The foundation provides the grants to physicians in FEMA-declared disaster areas to help them rebuild or restore their damaged medical practices in those locations, according to the AMA.

'Free' Rx Samples Expensive

Free drug samples provided to physicians by pharmaceutical companies actually could cost uninsured patients more in the long run, because those patients are prescribed brand-name drugs rather than generics, according to a study done by researchers at Wake Forest University Baptist Medical Center, Winston-Salem, N.C. Physicians were three times more likely to prescribe generic medications to uninsured patients after drug samples were removed from their offices, according to the study, which looked at a large, university-affiliated internal medicine practice. After the clinic closed its drug sample closet, the percentage of prescribed generic medications rose from 12% to 40%, the researchers found. “It's true that samples can save patients money in the short run, but our study shows that they may end up paying more in the long run when they are given prescriptions for brand-name-only drugs,” Dr. David Miller, an internist and the study's lead researcher, said in a statement.

Tools' Usefulness Limited

Although health plans are developing tools to help consumers compare price and quality information across hospitals and physicians, the tools' pervasiveness and usefulness are limited, according to a study by the Center for Studying Health System Change. The information provided as part of the tools often lacks specificity about individual providers, and its availability often is limited to enrollees in specific geographic areas, the study showed. When providing quality information, health plans generally rely on third-party sources to package publicly available information instead of using information from their own claims, the study found. “None of the health plans we interviewed believed that price and quality information is being used extensively by their enrollees today, in part because few have incentives in their benefit structures to encourage cost comparisons,” Ann Tynan, HSC researcher and study coauthor, said in a statement.

Many Reach 'Doughnut Hole'

One in four Medicare Part D enrollees who filled prescriptions in 2007 reached the gap in coverage known as the “doughnut hole,” and most remained in the doughnut hole for the rest of the year, according to an analysis from the Kaiser Family Foundation. The analysis suggested that about 3.4 million beneficiaries—14% of all Part D enrollees—reached the coverage gap last year and paid the full cost of their prescriptions for part of 2007. Beneficiaries taking drugs for serious chronic conditions had a substantially higher risk of a gap in coverage under their Medicare drug plan, the study found. For example, 64% of enrollees taking medications for Alzheimer's disease reached the coverage gap in 2007, as did 51% of those taking oral diabetes medications and 45% of patients on antidepressants, the study found. The analysis excluded beneficiaries who receive low-income subsidies because they do not face a gap in coverage under their Medicare drug plan.

Media Influences Tobacco Use

Media communications—including movies, advertising, and news—play a key role in shaping tobacco use, according to a lengthy report from the National Cancer Institute. The report noted that cigarettes are among the most heavily marketed products in the United States, and that most of the cigarette industry's marketing budget is allocated to promotional activities, especially for price discounts, which accounted for 75% of the industry's $10 billion in total marketing expenditures in 2005. Depictions of cigarette smoking are pervasive in movies, occurring in three-quarters or more of contemporary box office hits, the NCI report said, adding that the weight of evidence indicates a causal relationship between exposure to depictions of smoking in movies and youth smoking initiation. The NCI report provides the government's strongest conclusion to date on the media's powerful and causal effect on tobacco use, Dr. Cheryl Healton, president and CEO of the American Legacy Foundation, said in a statement. “This report provides the ammunition to tobacco control advocates around the world who are fighting to keep movies smoke free,” Dr. Healton said.

Tobacco Control Support Drops

Budgets for tobacco control programs in most states are either staying level or declining, despite increases in payments from the 1997 Tobacco Master Settlement Agreement, designed to compensate states for some of the cost of smoking-related illnesses, the American Lung Association reported. The ALA report blamed the stable or reduced tobacco control budgets on the poor economy in a number of states. The passage of smoke-free air laws also has slowed down in most states, the ALA found. Only two states this year—Iowa and Nebraska—have approved legislation to strengthen existing laws. And activity on cigarette tax increases in 2008 has been slower than in previous years, with only two states and the District of Columbia approving increases, the report said. New York's increase in the cigarette tax is the highest, at $1.25 a pack, the ALA said.

Grants to Doctors in Hurricanes

The AMA Foundation's Health Care Recovery Fund will provide grants of up to $2,500 to physicians in places declared disaster areas by the Federal Emergency Management Agency, and the foundation is accepting donations to help physicians who have been directly affected by Hurricane Gustav, which hit Louisiana, Mississippi, and Texas. The foundation provides the grants to physicians in FEMA-declared disaster areas to help them rebuild or restore their damaged medical practices in those locations, according to the AMA.

'Free' Rx Samples Expensive

Free drug samples provided to physicians by pharmaceutical companies actually could cost uninsured patients more in the long run, because those patients are prescribed brand-name drugs rather than generics, according to a study done by researchers at Wake Forest University Baptist Medical Center, Winston-Salem, N.C. Physicians were three times more likely to prescribe generic medications to uninsured patients after drug samples were removed from their offices, according to the study, which looked at a large, university-affiliated internal medicine practice. After the clinic closed its drug sample closet, the percentage of prescribed generic medications rose from 12% to 40%, the researchers found. “It's true that samples can save patients money in the short run, but our study shows that they may end up paying more in the long run when they are given prescriptions for brand-name-only drugs,” Dr. David Miller, an internist and the study's lead researcher, said in a statement.

Tools' Usefulness Limited

Although health plans are developing tools to help consumers compare price and quality information across hospitals and physicians, the tools' pervasiveness and usefulness are limited, according to a study by the Center for Studying Health System Change. The information provided as part of the tools often lacks specificity about individual providers, and its availability often is limited to enrollees in specific geographic areas, the study showed. When providing quality information, health plans generally rely on third-party sources to package publicly available information instead of using information from their own claims, the study found. “None of the health plans we interviewed believed that price and quality information is being used extensively by their enrollees today, in part because few have incentives in their benefit structures to encourage cost comparisons,” Ann Tynan, HSC researcher and study coauthor, said in a statement.

Many Reach 'Doughnut Hole'

One in four Medicare Part D enrollees who filled prescriptions in 2007 reached the gap in coverage known as the “doughnut hole,” and most remained in the doughnut hole for the rest of the year, according to an analysis from the Kaiser Family Foundation. The analysis suggested that about 3.4 million beneficiaries—14% of all Part D enrollees—reached the coverage gap last year and paid the full cost of their prescriptions for part of 2007. Beneficiaries taking drugs for serious chronic conditions had a substantially higher risk of a gap in coverage under their Medicare drug plan, the study found. For example, 64% of enrollees taking medications for Alzheimer's disease reached the coverage gap in 2007, as did 51% of those taking oral diabetes medications and 45% of patients on antidepressants, the study found. The analysis excluded beneficiaries who receive low-income subsidies because they do not face a gap in coverage under their Medicare drug plan.

Media Influences Tobacco Use

Media communications—including movies, advertising, and news—play a key role in shaping tobacco use, according to a lengthy report from the National Cancer Institute. The report noted that cigarettes are among the most heavily marketed products in the United States, and that most of the cigarette industry's marketing budget is allocated to promotional activities, especially for price discounts, which accounted for 75% of the industry's $10 billion in total marketing expenditures in 2005. Depictions of cigarette smoking are pervasive in movies, occurring in three-quarters or more of contemporary box office hits, the NCI report said, adding that the weight of evidence indicates a causal relationship between exposure to depictions of smoking in movies and youth smoking initiation. The NCI report provides the government's strongest conclusion to date on the media's powerful and causal effect on tobacco use, Dr. Cheryl Healton, president and CEO of the American Legacy Foundation, said in a statement. “This report provides the ammunition to tobacco control advocates around the world who are fighting to keep movies smoke free,” Dr. Healton said.

Tobacco Control Support Drops

Budgets for tobacco control programs in most states are either staying level or declining, despite increases in payments from the 1997 Tobacco Master Settlement Agreement, designed to compensate states for some of the cost of smoking-related illnesses, the American Lung Association reported. The ALA report blamed the stable or reduced tobacco control budgets on the poor economy in a number of states. The passage of smoke-free air laws also has slowed down in most states, the ALA found. Only two states this year—Iowa and Nebraska—have approved legislation to strengthen existing laws. And activity on cigarette tax increases in 2008 has been slower than in previous years, with only two states and the District of Columbia approving increases, the report said. New York's increase in the cigarette tax is the highest, at $1.25 a pack, the ALA said.

Grants to Doctors in Hurricanes

The AMA Foundation's Health Care Recovery Fund will provide grants of up to $2,500 to physicians in places declared disaster areas by the Federal Emergency Management Agency, and the foundation is accepting donations to help physicians who have been directly affected by Hurricane Gustav, which hit Louisiana, Mississippi, and Texas. The foundation provides the grants to physicians in FEMA-declared disaster areas to help them rebuild or restore their damaged medical practices in those locations, according to the AMA.

'Free' Rx Samples Expensive

Free drug samples provided to physicians by pharmaceutical companies actually could cost uninsured patients more in the long run, because those patients are prescribed brand-name drugs rather than generics, according to a study done by researchers at Wake Forest University Baptist Medical Center, Winston-Salem, N.C. Physicians were three times more likely to prescribe generic medications to uninsured patients after drug samples were removed from their offices, according to the study, which looked at a large, university-affiliated internal medicine practice. After the clinic closed its drug sample closet, the percentage of prescribed generic medications rose from 12% to 40%, the researchers found. “It's true that samples can save patients money in the short run, but our study shows that they may end up paying more in the long run when they are given prescriptions for brand-name-only drugs,” Dr. David Miller, an internist and the study's lead researcher, said in a statement.

Tools' Usefulness Limited

Although health plans are developing tools to help consumers compare price and quality information across hospitals and physicians, the tools' pervasiveness and usefulness are limited, according to a study by the Center for Studying Health System Change. The information provided as part of the tools often lacks specificity about individual providers, and its availability often is limited to enrollees in specific geographic areas, the study showed. When providing quality information, health plans generally rely on third-party sources to package publicly available information instead of using information from their own claims, the study found. “None of the health plans we interviewed believed that price and quality information is being used extensively by their enrollees today, in part because few have incentives in their benefit structures to encourage cost comparisons,” Ann Tynan, HSC researcher and study coauthor, said in a statement.

Many Reach 'Doughnut Hole'

One in four Medicare Part D enrollees who filled prescriptions in 2007 reached the gap in coverage known as the “doughnut hole,” and most remained in the doughnut hole for the rest of the year, according to an analysis from the Kaiser Family Foundation. The analysis suggested that about 3.4 million beneficiaries—14% of all Part D enrollees—reached the coverage gap last year and paid the full cost of their prescriptions for part of 2007. Beneficiaries taking drugs for serious chronic conditions had a substantially higher risk of a gap in coverage under their Medicare drug plan, the study found. For example, 64% of enrollees taking medications for Alzheimer's disease reached the coverage gap in 2007, as did 51% of those taking oral diabetes medications and 45% of patients on antidepressants, the study found. The analysis excluded beneficiaries who receive low-income subsidies because they do not face a gap in coverage under their Medicare drug plan.

Access to care has declined significantly since 2003, with 42% of all working-age adults either uninsured or underinsured in 2007, according to a national health system scorecard from the Commonwealth Fund, which found that health care system performance in the United States has worsened slightly overall since 2006.

According to the scorecard report, the United States on average continues to fall far short on key indicators of health outcomes and quality. U.S. scores are particularly low on efficiency, compared with top performers inside the country—states, regions, hospitals, health plans, or other providers—and internationally.

“These findings were very disturbing, considering the resources the U.S. spends on health care,” Dr. Karen Davis, president of the Commonwealth Fund, said in a briefing on the report, adding that the nation spends more on health care than any other in the industrialized world.

In the report, “Why Not the Best? Results From the National Scorecard on U.S. Health System Performance, 2008,” the United States scored an average of 65 out of a possible 100—slightly below the 67 scored in 2006 in the first scorecard released—across 37 key indicators of health outcomes, quality, access, efficiency, and equity.

“We need to change direction,” Dr. Davis said. “This latest scorecard demonstrates that we are in fact losing ground.”

The report found that the number of uninsured and underinsured Americans continues to rise: As of 2007, 42% of all working-age adults were either uninsured or underinsured—up from 35% in 2003.

In addition, the report said that the United States failed to keep up with improvements made in other countries, and fell from 15th place to dead last among 19 industrialized nations in premature deaths that could have been prevented by timely access to effective health care.

Rates for basic preventive care, such as cancer screening, failed to improve from 2005 to 2007, the report said.

Also, “scores on efficiency are particularly low, pulled down by fragmented, poorly coordinated care,” along with lack of access to care and high administrative costs, said Cathy Schoen, senior vice president of the Commonwealth Fund.

In 2007, for example, as in 2005, patients in the United States were three to four times more likely than patients in other countries to report having had duplicate tests or to report that medical records or test results were not available at the time of their appointment. And although primary care physicians in the United States used electronic medical records (EMRs) increasingly from 2001 to 2006—17% to 28%—the United States lags far behind leading countries, where EMRs now are used by nearly all physicians (98%) to improve care, the scorecard reported.

Still, “there are some bright spots,” Ms. Schoen said. The report found evidence that focusing on specific areas through targeted initiatives can yield substantial improvement.

For example, the report found that hospital standardized mortality ratios, a key indicator of patient safety, improved by 19% over 5 years, following broad public and private efforts to assess and improve hospital safety. Also, chronic care and acute hospital care quality metrics that have been the focus of public reporting, pay for performance, and improvement efforts also showed significant progress.

“We find that what gets attention gets improved,” Ms. Schoen said. “But to date we have focused too narrowly. Current initiatives often fail to encourage more effective or more efficient care.”

Dr. Davis pointed out that, with a new president and administration coming soon, the United States has a real opportunity to refocus and rebuild its health care system.

“The most important thing is extending health insurance to all,” she said. “There were 75 million American adults uninsured at some point in the year, and obviously that affects performance throughout the scorecard.”

Access to care has declined significantly since 2003, with 42% of all working-age adults either uninsured or underinsured in 2007, according to a national health system scorecard from the Commonwealth Fund, which found that health care system performance in the United States has worsened slightly overall since 2006.

According to the scorecard report, the United States on average continues to fall far short on key indicators of health outcomes and quality. U.S. scores are particularly low on efficiency, compared with top performers inside the country—states, regions, hospitals, health plans, or other providers—and internationally.

“These findings were very disturbing, considering the resources the U.S. spends on health care,” Dr. Karen Davis, president of the Commonwealth Fund, said in a briefing on the report, adding that the nation spends more on health care than any other in the industrialized world.

In the report, “Why Not the Best? Results From the National Scorecard on U.S. Health System Performance, 2008,” the United States scored an average of 65 out of a possible 100—slightly below the 67 scored in 2006 in the first scorecard released—across 37 key indicators of health outcomes, quality, access, efficiency, and equity.

“We need to change direction,” Dr. Davis said. “This latest scorecard demonstrates that we are in fact losing ground.”

The report found that the number of uninsured and underinsured Americans continues to rise: As of 2007, 42% of all working-age adults were either uninsured or underinsured—up from 35% in 2003.

In addition, the report said that the United States failed to keep up with improvements made in other countries, and fell from 15th place to dead last among 19 industrialized nations in premature deaths that could have been prevented by timely access to effective health care.

Rates for basic preventive care, such as cancer screening, failed to improve from 2005 to 2007, the report said.

Also, “scores on efficiency are particularly low, pulled down by fragmented, poorly coordinated care,” along with lack of access to care and high administrative costs, said Cathy Schoen, senior vice president of the Commonwealth Fund.

In 2007, for example, as in 2005, patients in the United States were three to four times more likely than patients in other countries to report having had duplicate tests or to report that medical records or test results were not available at the time of their appointment. And although primary care physicians in the United States used electronic medical records (EMRs) increasingly from 2001 to 2006—17% to 28%—the United States lags far behind leading countries, where EMRs now are used by nearly all physicians (98%) to improve care, the scorecard reported.

Still, “there are some bright spots,” Ms. Schoen said. The report found evidence that focusing on specific areas through targeted initiatives can yield substantial improvement.

For example, the report found that hospital standardized mortality ratios, a key indicator of patient safety, improved by 19% over 5 years, following broad public and private efforts to assess and improve hospital safety. Also, chronic care and acute hospital care quality metrics that have been the focus of public reporting, pay for performance, and improvement efforts also showed significant progress.

“We find that what gets attention gets improved,” Ms. Schoen said. “But to date we have focused too narrowly. Current initiatives often fail to encourage more effective or more efficient care.”

Dr. Davis pointed out that, with a new president and administration coming soon, the United States has a real opportunity to refocus and rebuild its health care system.

“The most important thing is extending health insurance to all,” she said. “There were 75 million American adults uninsured at some point in the year, and obviously that affects performance throughout the scorecard.”

Access to care has declined significantly since 2003, with 42% of all working-age adults either uninsured or underinsured in 2007, according to a national health system scorecard from the Commonwealth Fund, which found that health care system performance in the United States has worsened slightly overall since 2006.

According to the scorecard report, the United States on average continues to fall far short on key indicators of health outcomes and quality. U.S. scores are particularly low on efficiency, compared with top performers inside the country—states, regions, hospitals, health plans, or other providers—and internationally.

“These findings were very disturbing, considering the resources the U.S. spends on health care,” Dr. Karen Davis, president of the Commonwealth Fund, said in a briefing on the report, adding that the nation spends more on health care than any other in the industrialized world.

In the report, “Why Not the Best? Results From the National Scorecard on U.S. Health System Performance, 2008,” the United States scored an average of 65 out of a possible 100—slightly below the 67 scored in 2006 in the first scorecard released—across 37 key indicators of health outcomes, quality, access, efficiency, and equity.

“We need to change direction,” Dr. Davis said. “This latest scorecard demonstrates that we are in fact losing ground.”

The report found that the number of uninsured and underinsured Americans continues to rise: As of 2007, 42% of all working-age adults were either uninsured or underinsured—up from 35% in 2003.

In addition, the report said that the United States failed to keep up with improvements made in other countries, and fell from 15th place to dead last among 19 industrialized nations in premature deaths that could have been prevented by timely access to effective health care.

Rates for basic preventive care, such as cancer screening, failed to improve from 2005 to 2007, the report said.

Also, “scores on efficiency are particularly low, pulled down by fragmented, poorly coordinated care,” along with lack of access to care and high administrative costs, said Cathy Schoen, senior vice president of the Commonwealth Fund.

In 2007, for example, as in 2005, patients in the United States were three to four times more likely than patients in other countries to report having had duplicate tests or to report that medical records or test results were not available at the time of their appointment. And although primary care physicians in the United States used electronic medical records (EMRs) increasingly from 2001 to 2006—17% to 28%—the United States lags far behind leading countries, where EMRs now are used by nearly all physicians (98%) to improve care, the scorecard reported.

Still, “there are some bright spots,” Ms. Schoen said. The report found evidence that focusing on specific areas through targeted initiatives can yield substantial improvement.

For example, the report found that hospital standardized mortality ratios, a key indicator of patient safety, improved by 19% over 5 years, following broad public and private efforts to assess and improve hospital safety. Also, chronic care and acute hospital care quality metrics that have been the focus of public reporting, pay for performance, and improvement efforts also showed significant progress.

“We find that what gets attention gets improved,” Ms. Schoen said. “But to date we have focused too narrowly. Current initiatives often fail to encourage more effective or more efficient care.”

Dr. Davis pointed out that, with a new president and administration coming soon, the United States has a real opportunity to refocus and rebuild its health care system.

“The most important thing is extending health insurance to all,” she said. “There were 75 million American adults uninsured at some point in the year, and obviously that affects performance throughout the scorecard.”

NEJM Editors Support Plaintiff

Ten current and former New England Journal of Medicine editors have sided with the plaintiff in a U.S. Supreme Court case that could determine how much the Food and Drug Administration's approval of drugs can shield drug manufacturers from subsequent lawsuits. The high court is scheduled to hear the case, Wyeth v. Levine, on Nov. 3. The plaintiff, Vermont musician Diana Levine, had her right arm amputated after an infection she said was brought on by an injection of promethazine (Phenergan). She won a judgment of $6.8 million in a Vermont court. Wyeth contends that FDA approval should shield drug makers from state-based lawsuits—a legal doctrine known as preemption. “Because the preemption of state failure-to-warn claims involving prescription drugs would threaten this nation's public health by eliminating a necessary counterpart to the FDA, Amici urge this court to affirm the decision” of the Vermont court, the journal editors wrote in the brief they filed with the Supreme Court.

P4P Working, Says CMS

Providers that participated in a Medicare pay-for-performance demonstration program earned $16.7 million in incentive payments during the program's second year by improving the quality of care for patients with several chronic conditions, including heart failure, coronary artery disease, and diabetes, according to the Centers for Medicare and Medicaid Services. All 10 of the participating physician groups achieved benchmark or target performance on at least 25 out of 27 quality markers for patients with diabetes, coronary artery disease and heart failure. Five of the groups achieved benchmark quality performance on all 27 quality measures. The groups improved their performance by changing some of their office processes and investing in health information technology. “These results show that by working in collaboration with the physician groups on new and innovative ways to reimburse for high quality care, we are on the right track to find a better way to pay physicians,” said Kerry Weems, CMS acting administrator. The demonstration project was originally scheduled to last 3 years but has since been extended to a fourth year.

Part D Premiums for 2009

On average, Medicare beneficiaries can expect to pay about $28 per month for standard Part D prescription drug coverage next year. The estimates from the CMS are based on bids submitted for both prescription drug plans and Medicare Advantage drug plans. The estimated monthly premiums are about $3 higher than the average monthly premium costs this year, but are 37% lower than projections that were made when the Medicare prescription drug benefit was created in 2003. The $3 increase is based in part on rising drug costs in general and higher costs for catastrophic drug coverage. In some cases, price increases could be significant, Mr. Weems said during a teleconference. However, he noted that most beneficiaries will have the option to switch to a prescription drug plan with the same or lower premiums as they paid this year. Open enrollment for the fourth year of the Medicare Part D program is set to begin in November.

Genomics Collaboration

Pharmacy benefit manager Medco Health Solutions and the FDA have partnered to study genetic testing and the impact of genetics prescription drug efficacy, according to Medco. The agreement extends to Aug. 31, 2010. Over the next 2 years, Medco will deliver a series of reports to the FDA that will address the safety of prescription drugs, physician participation in pharmacogenomics testing, the usefulness of the tests in prescribing, and quantifying prescription information that contains genetic information. Medco said its reports will be derived from clinical settings, including one that will examine whether physicians are willing to change the dose of a prescription based on a genetic test result. “Studying this field can advance pharmacy care to remove some of the trial and error in how medications are prescribed,” said Dr. Robert Epstein, Medco chief medical officer.

Uninsured Spend $30B on Care

Americans who lack health insurance for any part of 2008 will spend $30 billion out of pocket for health services and also receive $56 billion in uncompensated care while uninsured, according to a study in Health Affairs. Government programs will pay for about $43 billion for the uncompensated care, the researchers reported. Compared with people who have full-year private health care coverage, people who are uninsured for a full year receive less than half as much care but pay a larger share out of pocket, the authors reported. Someone who is uninsured all year would pay 35%, or $583 on average, out of pocket toward average annual medical costs of $1,686, the study said. In contrast, annual medical costs of the privately insured average $3,915, with 17%, or $681 on average, paid out of pocket, according to the study.

CHCs Star in Preventive Care

Community health centers outperform other primary care providers in the use of preventive care, despite their more vulnerable patient population, according to a study from George Washington University. The analysis showed that health centers, which primarily serve Medicaid and uninsured patients, achieved significantly higher levels of preventive health care—in some cases up to 22% higher—in key areas, including screening for diabetes, breast cancer, cervical cancer, and hypertension. The study used data from the Medical Expenditure Panel Survey to compare use of preventive services by adults aged 25–64 years who visited community health centers.

NEJM Editors Support Plaintiff

Ten current and former New England Journal of Medicine editors have sided with the plaintiff in a U.S. Supreme Court case that could determine how much the Food and Drug Administration's approval of drugs can shield drug manufacturers from subsequent lawsuits. The high court is scheduled to hear the case, Wyeth v. Levine, on Nov. 3. The plaintiff, Vermont musician Diana Levine, had her right arm amputated after an infection she said was brought on by an injection of promethazine (Phenergan). She won a judgment of $6.8 million in a Vermont court. Wyeth contends that FDA approval should shield drug makers from state-based lawsuits—a legal doctrine known as preemption. “Because the preemption of state failure-to-warn claims involving prescription drugs would threaten this nation's public health by eliminating a necessary counterpart to the FDA, Amici urge this court to affirm the decision” of the Vermont court, the journal editors wrote in the brief they filed with the Supreme Court.

P4P Working, Says CMS

Providers that participated in a Medicare pay-for-performance demonstration program earned $16.7 million in incentive payments during the program's second year by improving the quality of care for patients with several chronic conditions, including heart failure, coronary artery disease, and diabetes, according to the Centers for Medicare and Medicaid Services. All 10 of the participating physician groups achieved benchmark or target performance on at least 25 out of 27 quality markers for patients with diabetes, coronary artery disease and heart failure. Five of the groups achieved benchmark quality performance on all 27 quality measures. The groups improved their performance by changing some of their office processes and investing in health information technology. “These results show that by working in collaboration with the physician groups on new and innovative ways to reimburse for high quality care, we are on the right track to find a better way to pay physicians,” said Kerry Weems, CMS acting administrator. The demonstration project was originally scheduled to last 3 years but has since been extended to a fourth year.

Part D Premiums for 2009

On average, Medicare beneficiaries can expect to pay about $28 per month for standard Part D prescription drug coverage next year. The estimates from the CMS are based on bids submitted for both prescription drug plans and Medicare Advantage drug plans. The estimated monthly premiums are about $3 higher than the average monthly premium costs this year, but are 37% lower than projections that were made when the Medicare prescription drug benefit was created in 2003. The $3 increase is based in part on rising drug costs in general and higher costs for catastrophic drug coverage. In some cases, price increases could be significant, Mr. Weems said during a teleconference. However, he noted that most beneficiaries will have the option to switch to a prescription drug plan with the same or lower premiums as they paid this year. Open enrollment for the fourth year of the Medicare Part D program is set to begin in November.

Genomics Collaboration

Pharmacy benefit manager Medco Health Solutions and the FDA have partnered to study genetic testing and the impact of genetics prescription drug efficacy, according to Medco. The agreement extends to Aug. 31, 2010. Over the next 2 years, Medco will deliver a series of reports to the FDA that will address the safety of prescription drugs, physician participation in pharmacogenomics testing, the usefulness of the tests in prescribing, and quantifying prescription information that contains genetic information. Medco said its reports will be derived from clinical settings, including one that will examine whether physicians are willing to change the dose of a prescription based on a genetic test result. “Studying this field can advance pharmacy care to remove some of the trial and error in how medications are prescribed,” said Dr. Robert Epstein, Medco chief medical officer.

Uninsured Spend $30B on Care

Americans who lack health insurance for any part of 2008 will spend $30 billion out of pocket for health services and also receive $56 billion in uncompensated care while uninsured, according to a study in Health Affairs. Government programs will pay for about $43 billion for the uncompensated care, the researchers reported. Compared with people who have full-year private health care coverage, people who are uninsured for a full year receive less than half as much care but pay a larger share out of pocket, the authors reported. Someone who is uninsured all year would pay 35%, or $583 on average, out of pocket toward average annual medical costs of $1,686, the study said. In contrast, annual medical costs of the privately insured average $3,915, with 17%, or $681 on average, paid out of pocket, according to the study.

CHCs Star in Preventive Care

Community health centers outperform other primary care providers in the use of preventive care, despite their more vulnerable patient population, according to a study from George Washington University. The analysis showed that health centers, which primarily serve Medicaid and uninsured patients, achieved significantly higher levels of preventive health care—in some cases up to 22% higher—in key areas, including screening for diabetes, breast cancer, cervical cancer, and hypertension. The study used data from the Medical Expenditure Panel Survey to compare use of preventive services by adults aged 25–64 years who visited community health centers.

NEJM Editors Support Plaintiff

Ten current and former New England Journal of Medicine editors have sided with the plaintiff in a U.S. Supreme Court case that could determine how much the Food and Drug Administration's approval of drugs can shield drug manufacturers from subsequent lawsuits. The high court is scheduled to hear the case, Wyeth v. Levine, on Nov. 3. The plaintiff, Vermont musician Diana Levine, had her right arm amputated after an infection she said was brought on by an injection of promethazine (Phenergan). She won a judgment of $6.8 million in a Vermont court. Wyeth contends that FDA approval should shield drug makers from state-based lawsuits—a legal doctrine known as preemption. “Because the preemption of state failure-to-warn claims involving prescription drugs would threaten this nation's public health by eliminating a necessary counterpart to the FDA, Amici urge this court to affirm the decision” of the Vermont court, the journal editors wrote in the brief they filed with the Supreme Court.

P4P Working, Says CMS

Providers that participated in a Medicare pay-for-performance demonstration program earned $16.7 million in incentive payments during the program's second year by improving the quality of care for patients with several chronic conditions, including heart failure, coronary artery disease, and diabetes, according to the Centers for Medicare and Medicaid Services. All 10 of the participating physician groups achieved benchmark or target performance on at least 25 out of 27 quality markers for patients with diabetes, coronary artery disease and heart failure. Five of the groups achieved benchmark quality performance on all 27 quality measures. The groups improved their performance by changing some of their office processes and investing in health information technology. “These results show that by working in collaboration with the physician groups on new and innovative ways to reimburse for high quality care, we are on the right track to find a better way to pay physicians,” said Kerry Weems, CMS acting administrator. The demonstration project was originally scheduled to last 3 years but has since been extended to a fourth year.

Part D Premiums for 2009

On average, Medicare beneficiaries can expect to pay about $28 per month for standard Part D prescription drug coverage next year. The estimates from the CMS are based on bids submitted for both prescription drug plans and Medicare Advantage drug plans. The estimated monthly premiums are about $3 higher than the average monthly premium costs this year, but are 37% lower than projections that were made when the Medicare prescription drug benefit was created in 2003. The $3 increase is based in part on rising drug costs in general and higher costs for catastrophic drug coverage. In some cases, price increases could be significant, Mr. Weems said during a teleconference. However, he noted that most beneficiaries will have the option to switch to a prescription drug plan with the same or lower premiums as they paid this year. Open enrollment for the fourth year of the Medicare Part D program is set to begin in November.

Genomics Collaboration

Pharmacy benefit manager Medco Health Solutions and the FDA have partnered to study genetic testing and the impact of genetics prescription drug efficacy, according to Medco. The agreement extends to Aug. 31, 2010. Over the next 2 years, Medco will deliver a series of reports to the FDA that will address the safety of prescription drugs, physician participation in pharmacogenomics testing, the usefulness of the tests in prescribing, and quantifying prescription information that contains genetic information. Medco said its reports will be derived from clinical settings, including one that will examine whether physicians are willing to change the dose of a prescription based on a genetic test result. “Studying this field can advance pharmacy care to remove some of the trial and error in how medications are prescribed,” said Dr. Robert Epstein, Medco chief medical officer.

Uninsured Spend $30B on Care

Americans who lack health insurance for any part of 2008 will spend $30 billion out of pocket for health services and also receive $56 billion in uncompensated care while uninsured, according to a study in Health Affairs. Government programs will pay for about $43 billion for the uncompensated care, the researchers reported. Compared with people who have full-year private health care coverage, people who are uninsured for a full year receive less than half as much care but pay a larger share out of pocket, the authors reported. Someone who is uninsured all year would pay 35%, or $583 on average, out of pocket toward average annual medical costs of $1,686, the study said. In contrast, annual medical costs of the privately insured average $3,915, with 17%, or $681 on average, paid out of pocket, according to the study.

CHCs Star in Preventive Care

Community health centers outperform other primary care providers in the use of preventive care, despite their more vulnerable patient population, according to a study from George Washington University. The analysis showed that health centers, which primarily serve Medicaid and uninsured patients, achieved significantly higher levels of preventive health care—in some cases up to 22% higher—in key areas, including screening for diabetes, breast cancer, cervical cancer, and hypertension. The study used data from the Medical Expenditure Panel Survey to compare use of preventive services by adults aged 25–64 years who visited community health centers.

NEJM Editors Support Plaintiff

Ten current and former New England Journal of Medicine editors have sided with the plaintiff in a U.S. Supreme Court case that could determine how much the Food and Drug Administration's approval of drugs can shield drug manufacturers from subsequent lawsuits. The high court is scheduled to hear the case, Wyeth v. Levine, on Nov. 3. The plaintiff, Vermont musician Diana Levine, had her right arm amputated after an infection she said was brought on by an injection of promethazine (Phenergan). She won a judgment of $6.8 million in a Vermont court. Wyeth contends that FDA approval should shield drug makers from state-based lawsuits—a legal doctrine known as preemption. “Because the preemption of state failure-to-warn claims involving prescription drugs would threaten this nation's public health by eliminating a necessary counterpart to the FDA, Amici urge this court to affirm the decision” of the Vermont court, the journal editors wrote in the brief they filed with the Supreme Court.

P4P Working, CMS Says

Medical practices that participated in a Medicare pay-for-performance demonstration program earned $16.7 million in incentive payments during the program's second year by improving the quality of care for patients with several chronic conditions, including heart failure, coronary artery disease, and diabetes, according to the Centers for Medicare and Medicaid Services. All 10 of the participating physician groups achieved benchmark or target performance on at least 25 out of 27 quality markers for patients with diabetes, coronary artery disease, and heart failure. Five of the groups achieved benchmark quality performance on all 27 quality measures. The groups improved their performance by changing some office processes and investing in health information technology. “These results show that by working in collaboration with the physician groups on new and innovative ways to reimburse for high-quality care, we are on the right track to find a better way to pay physicians,” said Kerry Weems, CMS acting administrator. The demonstration project was originally scheduled to last 3 years but has been extended to a fourth year.

Part D Premiums for 2009

On average, Medicare beneficiaries can expect to pay about $28 per month for standard Part D prescription drug coverage next year. The estimates from the CMS are based on bids submitted for both prescription drug plans and Medicare Advantage drug plans. The estimated monthly premiums are about $3 higher than the average monthly premium costs this year, but are 37% lower than projections that were made when the Medicare prescription drug benefit was created in 2003. The $3 increase is based in part on rising drug costs in general and higher costs for catastrophic drug coverage. In some cases, price increases could be significant, Mr. Weems said during a teleconference. However, he noted that most beneficiaries will have the option to switch to a prescription drug plan with the same or lower premiums as they paid this year. Open enrollment for the fourth year of the Medicare Part D program is set to begin in November.

Genomics Collaboration

Pharmacy benefit manager Medco Health Solutions and the FDA have partnered to study genetic testing, according to Medco. The agreement extends to Aug. 31, 2010. Over the next 2 years, Medco will deliver a series of reports to the FDA that will address the safety of prescription drugs, physician participation in pharmacogenomics testing, the usefulness of the tests in prescribing, and quantifying prescription information that contains genetic information. Medco said its reports will be derived from clinical settings, including one that will examine whether physicians are willing to change the dose of a prescription based on a genetic test result. “Studying this field can advance pharmacy care to remove some of the trial and error in how medications are prescribed,” Dr. Robert Epstein, Medco chief medical officer, said in a statement.

Uninsured Spend $30B on Care

Americans who lack health insurance for any part of 2008 will spend $30 billion out of pocket for health services and receive $56 billion in uncompensated care while uninsured, according to a study in Health Affairs. Government programs will pay for about $43 billion for the uncompensated care, the researchers reported. Compared with people who have full-year private health care coverage, people who are uninsured for a full year receive less than half as much care but pay a larger share out of pocket, the authors reported. Someone who is uninsured all year would pay 35%, or $583 on average, out of pocket toward average annual medical costs of $1,686. In contrast, annual medical costs of the privately insured average $3,915, with 17%, or $681 on average, paid out of pocket.

NEJM Editors Support Plaintiff

Ten current and former New England Journal of Medicine editors have sided with the plaintiff in a U.S. Supreme Court case that could determine how much the Food and Drug Administration's approval of drugs can shield drug manufacturers from subsequent lawsuits. The high court is scheduled to hear the case, Wyeth v. Levine, on Nov. 3. The plaintiff, Vermont musician Diana Levine, had her right arm amputated after an infection she said was brought on by an injection of promethazine (Phenergan). She won a judgment of $6.8 million in a Vermont court. Wyeth contends that FDA approval should shield drug makers from state-based lawsuits—a legal doctrine known as preemption. “Because the preemption of state failure-to-warn claims involving prescription drugs would threaten this nation's public health by eliminating a necessary counterpart to the FDA, Amici urge this court to affirm the decision” of the Vermont court, the journal editors wrote in the brief they filed with the Supreme Court.

P4P Working, CMS Says

Medical practices that participated in a Medicare pay-for-performance demonstration program earned $16.7 million in incentive payments during the program's second year by improving the quality of care for patients with several chronic conditions, including heart failure, coronary artery disease, and diabetes, according to the Centers for Medicare and Medicaid Services. All 10 of the participating physician groups achieved benchmark or target performance on at least 25 out of 27 quality markers for patients with diabetes, coronary artery disease, and heart failure. Five of the groups achieved benchmark quality performance on all 27 quality measures. The groups improved their performance by changing some office processes and investing in health information technology. “These results show that by working in collaboration with the physician groups on new and innovative ways to reimburse for high-quality care, we are on the right track to find a better way to pay physicians,” said Kerry Weems, CMS acting administrator. The demonstration project was originally scheduled to last 3 years but has been extended to a fourth year.

Part D Premiums for 2009

On average, Medicare beneficiaries can expect to pay about $28 per month for standard Part D prescription drug coverage next year. The estimates from the CMS are based on bids submitted for both prescription drug plans and Medicare Advantage drug plans. The estimated monthly premiums are about $3 higher than the average monthly premium costs this year, but are 37% lower than projections that were made when the Medicare prescription drug benefit was created in 2003. The $3 increase is based in part on rising drug costs in general and higher costs for catastrophic drug coverage. In some cases, price increases could be significant, Mr. Weems said during a teleconference. However, he noted that most beneficiaries will have the option to switch to a prescription drug plan with the same or lower premiums as they paid this year. Open enrollment for the fourth year of the Medicare Part D program is set to begin in November.

Genomics Collaboration

Pharmacy benefit manager Medco Health Solutions and the FDA have partnered to study genetic testing, according to Medco. The agreement extends to Aug. 31, 2010. Over the next 2 years, Medco will deliver a series of reports to the FDA that will address the safety of prescription drugs, physician participation in pharmacogenomics testing, the usefulness of the tests in prescribing, and quantifying prescription information that contains genetic information. Medco said its reports will be derived from clinical settings, including one that will examine whether physicians are willing to change the dose of a prescription based on a genetic test result. “Studying this field can advance pharmacy care to remove some of the trial and error in how medications are prescribed,” Dr. Robert Epstein, Medco chief medical officer, said in a statement.

Uninsured Spend $30B on Care

Americans who lack health insurance for any part of 2008 will spend $30 billion out of pocket for health services and receive $56 billion in uncompensated care while uninsured, according to a study in Health Affairs. Government programs will pay for about $43 billion for the uncompensated care, the researchers reported. Compared with people who have full-year private health care coverage, people who are uninsured for a full year receive less than half as much care but pay a larger share out of pocket, the authors reported. Someone who is uninsured all year would pay 35%, or $583 on average, out of pocket toward average annual medical costs of $1,686. In contrast, annual medical costs of the privately insured average $3,915, with 17%, or $681 on average, paid out of pocket.

NEJM Editors Support Plaintiff

Ten current and former New England Journal of Medicine editors have sided with the plaintiff in a U.S. Supreme Court case that could determine how much the Food and Drug Administration's approval of drugs can shield drug manufacturers from subsequent lawsuits. The high court is scheduled to hear the case, Wyeth v. Levine, on Nov. 3. The plaintiff, Vermont musician Diana Levine, had her right arm amputated after an infection she said was brought on by an injection of promethazine (Phenergan). She won a judgment of $6.8 million in a Vermont court. Wyeth contends that FDA approval should shield drug makers from state-based lawsuits—a legal doctrine known as preemption. “Because the preemption of state failure-to-warn claims involving prescription drugs would threaten this nation's public health by eliminating a necessary counterpart to the FDA, Amici urge this court to affirm the decision” of the Vermont court, the journal editors wrote in the brief they filed with the Supreme Court.

P4P Working, CMS Says

Medical practices that participated in a Medicare pay-for-performance demonstration program earned $16.7 million in incentive payments during the program's second year by improving the quality of care for patients with several chronic conditions, including heart failure, coronary artery disease, and diabetes, according to the Centers for Medicare and Medicaid Services. All 10 of the participating physician groups achieved benchmark or target performance on at least 25 out of 27 quality markers for patients with diabetes, coronary artery disease, and heart failure. Five of the groups achieved benchmark quality performance on all 27 quality measures. The groups improved their performance by changing some office processes and investing in health information technology. “These results show that by working in collaboration with the physician groups on new and innovative ways to reimburse for high-quality care, we are on the right track to find a better way to pay physicians,” said Kerry Weems, CMS acting administrator. The demonstration project was originally scheduled to last 3 years but has been extended to a fourth year.

Part D Premiums for 2009

On average, Medicare beneficiaries can expect to pay about $28 per month for standard Part D prescription drug coverage next year. The estimates from the CMS are based on bids submitted for both prescription drug plans and Medicare Advantage drug plans. The estimated monthly premiums are about $3 higher than the average monthly premium costs this year, but are 37% lower than projections that were made when the Medicare prescription drug benefit was created in 2003. The $3 increase is based in part on rising drug costs in general and higher costs for catastrophic drug coverage. In some cases, price increases could be significant, Mr. Weems said during a teleconference. However, he noted that most beneficiaries will have the option to switch to a prescription drug plan with the same or lower premiums as they paid this year. Open enrollment for the fourth year of the Medicare Part D program is set to begin in November.

Genomics Collaboration

Pharmacy benefit manager Medco Health Solutions and the FDA have partnered to study genetic testing, according to Medco. The agreement extends to Aug. 31, 2010. Over the next 2 years, Medco will deliver a series of reports to the FDA that will address the safety of prescription drugs, physician participation in pharmacogenomics testing, the usefulness of the tests in prescribing, and quantifying prescription information that contains genetic information. Medco said its reports will be derived from clinical settings, including one that will examine whether physicians are willing to change the dose of a prescription based on a genetic test result. “Studying this field can advance pharmacy care to remove some of the trial and error in how medications are prescribed,” Dr. Robert Epstein, Medco chief medical officer, said in a statement.

Uninsured Spend $30B on Care

Americans who lack health insurance for any part of 2008 will spend $30 billion out of pocket for health services and receive $56 billion in uncompensated care while uninsured, according to a study in Health Affairs. Government programs will pay for about $43 billion for the uncompensated care, the researchers reported. Compared with people who have full-year private health care coverage, people who are uninsured for a full year receive less than half as much care but pay a larger share out of pocket, the authors reported. Someone who is uninsured all year would pay 35%, or $583 on average, out of pocket toward average annual medical costs of $1,686. In contrast, annual medical costs of the privately insured average $3,915, with 17%, or $681 on average, paid out of pocket.

President Signs Product Safety Act

President George W. Bush has signed into law the Consumer Product Safety Improvement Act of 2008, which reauthorizes the Consumer Product Safety Commission for the first time in 18 years and overhauls various laws regarding products, especially those used by children. The new law bans phthalates in children's toys and child care articles, bans lead beyond a minute amount in products for children aged under 12 years, bans three-wheel all-terrain vehicles and strengthens regulation of other ATVs, and mandates premarket testing by certified laboratories of children's products for lead and for compliance with a wide range of safety standards. It also requires manufacturers to place distinguishing marks on products and packaging to aid in recalls of products. Problems with consumer product regulation were highlighted last fall when numerous consumer products, particularly children's toys, were deemed unsafe and were recalled, congressional bill supporters said.

Asthma Hospitalizations Fall

Hospitalizations of children principally for asthma fell by almost 60,000 between 1997 and 2006, according to the Agency for Healthcare Research and Quality. However, the number of children with asthma who were admitted to hospitals for other conditions rose by nearly 70,000 during the same period, the AHRQ said. In 2006, there were 335,000 hospital stays for children with asthma, the agency found. In 137,000 cases, the children were admitted specifically to treat asthma. In the remaining cases, the children had asthma but were being treated for another illness which often is directly related to asthma—for instance, pneumonia or bronchitis, the AHRQ found. In addition, the agency reported that children from poorer communities, where the average income was less than $37,000 a year, were 76% more likely to be admitted than were those from wealthier communities, where the average income was greater than $37,000 a year. And, poor children with asthma as a coexisting illness were 54% more likely to be hospitalized than were children from wealthier communities, the AHRQ reported.

Uninsured Kids Lack Care

Uninsured children are three times more likely not to visit a doctor's office in the course of a year than are insured children, who are far more likely to have had a regular checkup, according to a study from the Robert Wood Johnson Foundation and researchers at the University of Minnesota. In addition, more than one in three children with chronic conditions such as asthma and diabetes are covered by the State Children's Health Insurance Program or Medicaid, and data show that these children receive health services at the same levels as do chronically ill children with private insurance, while chronically ill children without coverage receive far less care. “SCHIP and Medicaid provide an important safety net for America's families, especially for families with chronically ill children,” Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, said in a statement. “Because of Medicaid and SCHIP, millions of kids can get regular checkups, take the medications they need to stay well, and see a doctor when they are sick.”

SCHIP Enrollees' Medicaid Data Eyed

An estimated 4% of children enrolled in SCHIP were eligible for Medicaid in 2006, according to a review by the Department of Health and Human Services' Office of the Inspector General (OIG). Also, 4.5% of SCHIP enrollees' records lacked the documentation to make a Medicaid eligibility determination. Federal regulations require states to screen SCHIP applicants for Medicaid eligibility before enrolling them in the program. The OIG, which examined case records of a random sample of 400 children from 36 states, recommended that the Centers for Medicare and Medicaid Services emphasize to states the need for accuracy in enrollment casework.

AntibioticSpray for Apples 'Bad Idea'

An Environmental Protection Agency decision permitting Michigan to spray the state's apple orchards with gentamicin risks undermining the value of the antibiotic to treat blood infections in newborns, along with other serious human infections, according to the Infectious Diseases Society of America. The EPAgranted the state of Michigan “emergency” permission to use the antibiotic, also used to treat gastrointestinal and urinary tract infections, to fight a tree disease called fire blight. Fire blight has become resistant to streptomycin, the antibiotic apple growers had been using. “At a time when bacteria are becoming increasingly resistant to many of our best antibiotics, it is an extremely bad idea to risk undermining gentamicin's effectiveness for treating human disease by using it to treat a disease in apples,” Dr. Donald Poretz, IDSA president, said in a statement.

President Signs Product Safety Act

President George W. Bush has signed into law the Consumer Product Safety Improvement Act of 2008, which reauthorizes the Consumer Product Safety Commission for the first time in 18 years and overhauls various laws regarding products, especially those used by children. The new law bans phthalates in children's toys and child care articles, bans lead beyond a minute amount in products for children aged under 12 years, bans three-wheel all-terrain vehicles and strengthens regulation of other ATVs, and mandates premarket testing by certified laboratories of children's products for lead and for compliance with a wide range of safety standards. It also requires manufacturers to place distinguishing marks on products and packaging to aid in recalls of products. Problems with consumer product regulation were highlighted last fall when numerous consumer products, particularly children's toys, were deemed unsafe and were recalled, congressional bill supporters said.

Asthma Hospitalizations Fall

Hospitalizations of children principally for asthma fell by almost 60,000 between 1997 and 2006, according to the Agency for Healthcare Research and Quality. However, the number of children with asthma who were admitted to hospitals for other conditions rose by nearly 70,000 during the same period, the AHRQ said. In 2006, there were 335,000 hospital stays for children with asthma, the agency found. In 137,000 cases, the children were admitted specifically to treat asthma. In the remaining cases, the children had asthma but were being treated for another illness which often is directly related to asthma—for instance, pneumonia or bronchitis, the AHRQ found. In addition, the agency reported that children from poorer communities, where the average income was less than $37,000 a year, were 76% more likely to be admitted than were those from wealthier communities, where the average income was greater than $37,000 a year. And, poor children with asthma as a coexisting illness were 54% more likely to be hospitalized than were children from wealthier communities, the AHRQ reported.

Uninsured Kids Lack Care

Uninsured children are three times more likely not to visit a doctor's office in the course of a year than are insured children, who are far more likely to have had a regular checkup, according to a study from the Robert Wood Johnson Foundation and researchers at the University of Minnesota. In addition, more than one in three children with chronic conditions such as asthma and diabetes are covered by the State Children's Health Insurance Program or Medicaid, and data show that these children receive health services at the same levels as do chronically ill children with private insurance, while chronically ill children without coverage receive far less care. “SCHIP and Medicaid provide an important safety net for America's families, especially for families with chronically ill children,” Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, said in a statement. “Because of Medicaid and SCHIP, millions of kids can get regular checkups, take the medications they need to stay well, and see a doctor when they are sick.”

SCHIP Enrollees' Medicaid Data Eyed

An estimated 4% of children enrolled in SCHIP were eligible for Medicaid in 2006, according to a review by the Department of Health and Human Services' Office of the Inspector General (OIG). Also, 4.5% of SCHIP enrollees' records lacked the documentation to make a Medicaid eligibility determination. Federal regulations require states to screen SCHIP applicants for Medicaid eligibility before enrolling them in the program. The OIG, which examined case records of a random sample of 400 children from 36 states, recommended that the Centers for Medicare and Medicaid Services emphasize to states the need for accuracy in enrollment casework.

AntibioticSpray for Apples 'Bad Idea'

An Environmental Protection Agency decision permitting Michigan to spray the state's apple orchards with gentamicin risks undermining the value of the antibiotic to treat blood infections in newborns, along with other serious human infections, according to the Infectious Diseases Society of America. The EPAgranted the state of Michigan “emergency” permission to use the antibiotic, also used to treat gastrointestinal and urinary tract infections, to fight a tree disease called fire blight. Fire blight has become resistant to streptomycin, the antibiotic apple growers had been using. “At a time when bacteria are becoming increasingly resistant to many of our best antibiotics, it is an extremely bad idea to risk undermining gentamicin's effectiveness for treating human disease by using it to treat a disease in apples,” Dr. Donald Poretz, IDSA president, said in a statement.

President Signs Product Safety Act

President George W. Bush has signed into law the Consumer Product Safety Improvement Act of 2008, which reauthorizes the Consumer Product Safety Commission for the first time in 18 years and overhauls various laws regarding products, especially those used by children. The new law bans phthalates in children's toys and child care articles, bans lead beyond a minute amount in products for children aged under 12 years, bans three-wheel all-terrain vehicles and strengthens regulation of other ATVs, and mandates premarket testing by certified laboratories of children's products for lead and for compliance with a wide range of safety standards. It also requires manufacturers to place distinguishing marks on products and packaging to aid in recalls of products. Problems with consumer product regulation were highlighted last fall when numerous consumer products, particularly children's toys, were deemed unsafe and were recalled, congressional bill supporters said.

Asthma Hospitalizations Fall

Hospitalizations of children principally for asthma fell by almost 60,000 between 1997 and 2006, according to the Agency for Healthcare Research and Quality. However, the number of children with asthma who were admitted to hospitals for other conditions rose by nearly 70,000 during the same period, the AHRQ said. In 2006, there were 335,000 hospital stays for children with asthma, the agency found. In 137,000 cases, the children were admitted specifically to treat asthma. In the remaining cases, the children had asthma but were being treated for another illness which often is directly related to asthma—for instance, pneumonia or bronchitis, the AHRQ found. In addition, the agency reported that children from poorer communities, where the average income was less than $37,000 a year, were 76% more likely to be admitted than were those from wealthier communities, where the average income was greater than $37,000 a year. And, poor children with asthma as a coexisting illness were 54% more likely to be hospitalized than were children from wealthier communities, the AHRQ reported.

Uninsured Kids Lack Care

Uninsured children are three times more likely not to visit a doctor's office in the course of a year than are insured children, who are far more likely to have had a regular checkup, according to a study from the Robert Wood Johnson Foundation and researchers at the University of Minnesota. In addition, more than one in three children with chronic conditions such as asthma and diabetes are covered by the State Children's Health Insurance Program or Medicaid, and data show that these children receive health services at the same levels as do chronically ill children with private insurance, while chronically ill children without coverage receive far less care. “SCHIP and Medicaid provide an important safety net for America's families, especially for families with chronically ill children,” Dr. Risa Lavizzo-Mourey, president and CEO of the Robert Wood Johnson Foundation, said in a statement. “Because of Medicaid and SCHIP, millions of kids can get regular checkups, take the medications they need to stay well, and see a doctor when they are sick.”

SCHIP Enrollees' Medicaid Data Eyed

An estimated 4% of children enrolled in SCHIP were eligible for Medicaid in 2006, according to a review by the Department of Health and Human Services' Office of the Inspector General (OIG). Also, 4.5% of SCHIP enrollees' records lacked the documentation to make a Medicaid eligibility determination. Federal regulations require states to screen SCHIP applicants for Medicaid eligibility before enrolling them in the program. The OIG, which examined case records of a random sample of 400 children from 36 states, recommended that the Centers for Medicare and Medicaid Services emphasize to states the need for accuracy in enrollment casework.

AntibioticSpray for Apples 'Bad Idea'

An Environmental Protection Agency decision permitting Michigan to spray the state's apple orchards with gentamicin risks undermining the value of the antibiotic to treat blood infections in newborns, along with other serious human infections, according to the Infectious Diseases Society of America. The EPAgranted the state of Michigan “emergency” permission to use the antibiotic, also used to treat gastrointestinal and urinary tract infections, to fight a tree disease called fire blight. Fire blight has become resistant to streptomycin, the antibiotic apple growers had been using. “At a time when bacteria are becoming increasingly resistant to many of our best antibiotics, it is an extremely bad idea to risk undermining gentamicin's effectiveness for treating human disease by using it to treat a disease in apples,” Dr. Donald Poretz, IDSA president, said in a statement.

Access to care has declined significantly since 2003, with 42% of all working-age adults either uninsured or underinsured in 2007, according to a national health system scorecard from The Commonwealth Fund, which found that health care system performance in the United States has worsened slightly overall since 2006.

According to the scorecard report, the United States on average continues to fall far short on key indicators of health outcomes and quality. U.S. scores are particularly low on efficiency, compared with top performers inside the country—states, regions, hospitals, health plans, or other providers—and internationally.

“These findings were very disturbing, considering the resources the U.S. spends on health care,” Dr. Karen Davis, president of The Commonwealth Fund, said in a briefing on the report, adding that the nation spends more on health care than any other in the industrialized world.

In the report, “Why Not the Best? Results From the National Scorecard on U.S. Health System Performance, 2008,” the United States scored an average of 65 out of a possible 100—slightly below the 67 scored in 2006 in the first scorecard released—across 37 key indicators of health outcomes, quality, access, efficiency, and equity.

“This latest scorecard demonstrates that we are in fact losing ground,” Dr. Davis said.

The report found that the number of uninsured and underinsured Americans continues to rise: As of 2007, 42% of all working-age adults were either uninsured or underinsured—up from 35% in 2003.

The report showed that the United States failed to keep up with improvements made in other countries, and fell from 15th place to dead last among 19 industrialized nations in premature deaths that could have been prevented by timely access to effective health care.

Rates for basic preventive care, such as cancer screening, failed to improve from 2005 to 2007, the report said.

In addition, “scores on efficiency are particularly low, pulled down by fragmented, poorly coordinated care,” along with lack of access to care and high administrative costs, said Cathy Schoen, senior vice president of The Commonwealth Fund.

In 2007, for example, as in 2005, patients in the United States were three to four times more likely than patients in other countries to report having had duplicate tests or to report that medical records or test results were not available at the time of their appointment. And, although primary care physicians in the United States used electronic medical records (EMRs) increasingly from 2001 to 2006—17% to 28%—the United States lags far behind leading countries, where EMRs now are used by nearly all physicians (98%) to improve care, the scorecard reported.

Still, “there are some bright spots,” Ms. Schoen said. The report found evidence that focusing on specific areas through targeted initiatives can yield substantial improvement.

For example, the report found that hospital standardized mortality ratios, a key indicator of patient safety, improved by 19% over 5 years, following broad public and private efforts to assess and improve hospital safety. Also, chronic care and acute hospital care quality metrics that have been the focus of public reporting, pay for performance, and improvement efforts also showed significant progress.

“We find that what gets attention gets improved,” Ms. Schoen said. “But to date we have focused too narrowly. Current initiatives often fail to encourage more effective or more efficient care.”

Dr. Davis pointed out that, with a new president and administration next year, the United States has a real opportunity to refocus and rebuild its health care system.

“There were 75 million American adults uninsured at some point in the year, and obviously that affects performance throughout the scorecard,” she said.

Access to care has declined significantly since 2003, with 42% of all working-age adults either uninsured or underinsured in 2007, according to a national health system scorecard from The Commonwealth Fund, which found that health care system performance in the United States has worsened slightly overall since 2006.

According to the scorecard report, the United States on average continues to fall far short on key indicators of health outcomes and quality. U.S. scores are particularly low on efficiency, compared with top performers inside the country—states, regions, hospitals, health plans, or other providers—and internationally.

“These findings were very disturbing, considering the resources the U.S. spends on health care,” Dr. Karen Davis, president of The Commonwealth Fund, said in a briefing on the report, adding that the nation spends more on health care than any other in the industrialized world.

In the report, “Why Not the Best? Results From the National Scorecard on U.S. Health System Performance, 2008,” the United States scored an average of 65 out of a possible 100—slightly below the 67 scored in 2006 in the first scorecard released—across 37 key indicators of health outcomes, quality, access, efficiency, and equity.

“This latest scorecard demonstrates that we are in fact losing ground,” Dr. Davis said.

The report found that the number of uninsured and underinsured Americans continues to rise: As of 2007, 42% of all working-age adults were either uninsured or underinsured—up from 35% in 2003.

The report showed that the United States failed to keep up with improvements made in other countries, and fell from 15th place to dead last among 19 industrialized nations in premature deaths that could have been prevented by timely access to effective health care.

Rates for basic preventive care, such as cancer screening, failed to improve from 2005 to 2007, the report said.

In addition, “scores on efficiency are particularly low, pulled down by fragmented, poorly coordinated care,” along with lack of access to care and high administrative costs, said Cathy Schoen, senior vice president of The Commonwealth Fund.

In 2007, for example, as in 2005, patients in the United States were three to four times more likely than patients in other countries to report having had duplicate tests or to report that medical records or test results were not available at the time of their appointment. And, although primary care physicians in the United States used electronic medical records (EMRs) increasingly from 2001 to 2006—17% to 28%—the United States lags far behind leading countries, where EMRs now are used by nearly all physicians (98%) to improve care, the scorecard reported.

Still, “there are some bright spots,” Ms. Schoen said. The report found evidence that focusing on specific areas through targeted initiatives can yield substantial improvement.

For example, the report found that hospital standardized mortality ratios, a key indicator of patient safety, improved by 19% over 5 years, following broad public and private efforts to assess and improve hospital safety. Also, chronic care and acute hospital care quality metrics that have been the focus of public reporting, pay for performance, and improvement efforts also showed significant progress.

“We find that what gets attention gets improved,” Ms. Schoen said. “But to date we have focused too narrowly. Current initiatives often fail to encourage more effective or more efficient care.”

Dr. Davis pointed out that, with a new president and administration next year, the United States has a real opportunity to refocus and rebuild its health care system.

“There were 75 million American adults uninsured at some point in the year, and obviously that affects performance throughout the scorecard,” she said.

Access to care has declined significantly since 2003, with 42% of all working-age adults either uninsured or underinsured in 2007, according to a national health system scorecard from The Commonwealth Fund, which found that health care system performance in the United States has worsened slightly overall since 2006.

According to the scorecard report, the United States on average continues to fall far short on key indicators of health outcomes and quality. U.S. scores are particularly low on efficiency, compared with top performers inside the country—states, regions, hospitals, health plans, or other providers—and internationally.

“These findings were very disturbing, considering the resources the U.S. spends on health care,” Dr. Karen Davis, president of The Commonwealth Fund, said in a briefing on the report, adding that the nation spends more on health care than any other in the industrialized world.

In the report, “Why Not the Best? Results From the National Scorecard on U.S. Health System Performance, 2008,” the United States scored an average of 65 out of a possible 100—slightly below the 67 scored in 2006 in the first scorecard released—across 37 key indicators of health outcomes, quality, access, efficiency, and equity.

“This latest scorecard demonstrates that we are in fact losing ground,” Dr. Davis said.

The report found that the number of uninsured and underinsured Americans continues to rise: As of 2007, 42% of all working-age adults were either uninsured or underinsured—up from 35% in 2003.

The report showed that the United States failed to keep up with improvements made in other countries, and fell from 15th place to dead last among 19 industrialized nations in premature deaths that could have been prevented by timely access to effective health care.

Rates for basic preventive care, such as cancer screening, failed to improve from 2005 to 2007, the report said.

In addition, “scores on efficiency are particularly low, pulled down by fragmented, poorly coordinated care,” along with lack of access to care and high administrative costs, said Cathy Schoen, senior vice president of The Commonwealth Fund.

In 2007, for example, as in 2005, patients in the United States were three to four times more likely than patients in other countries to report having had duplicate tests or to report that medical records or test results were not available at the time of their appointment. And, although primary care physicians in the United States used electronic medical records (EMRs) increasingly from 2001 to 2006—17% to 28%—the United States lags far behind leading countries, where EMRs now are used by nearly all physicians (98%) to improve care, the scorecard reported.

Still, “there are some bright spots,” Ms. Schoen said. The report found evidence that focusing on specific areas through targeted initiatives can yield substantial improvement.

For example, the report found that hospital standardized mortality ratios, a key indicator of patient safety, improved by 19% over 5 years, following broad public and private efforts to assess and improve hospital safety. Also, chronic care and acute hospital care quality metrics that have been the focus of public reporting, pay for performance, and improvement efforts also showed significant progress.

“We find that what gets attention gets improved,” Ms. Schoen said. “But to date we have focused too narrowly. Current initiatives often fail to encourage more effective or more efficient care.”

Dr. Davis pointed out that, with a new president and administration next year, the United States has a real opportunity to refocus and rebuild its health care system.

“There were 75 million American adults uninsured at some point in the year, and obviously that affects performance throughout the scorecard,” she said.

Access to care has declined significantly since 2003, with 42% of all working-age adults either uninsured or underinsured in 2007, according to a national health system scorecard from The Commonwealth Fund, which found that health care system performance in the United States has worsened slightly overall since 2006.

According to the scorecard report, the United States on average continues to fall far short on key indicators of health outcomes and quality. U.S. scores are particularly low on efficiency, compared with top performers inside the country–states, regions, hospitals, health plans, or other providers–and internationally.

“These findings were very disturbing, considering the resources the U.S. spends on health care,” Dr. Karen Davis, president of The Commonwealth Fund, said in a briefing on the report, adding that the nation spends more on health care than any other in the industrialized world.

In the report, “Why Not the Best? Results From the National Scorecard on U.S. Health System Performance, 2008,” the United States scored an average of 65 out of a possible 100–slightly below the 67 scored in 2006 in the first scorecard released–across 37 key indicators of health outcomes, quality, access, efficiency, and equity.

“We need to change direction,” Dr. Davis said. “This latest scorecard demonstrates that we are in fact losing ground.”

The report found that the number of uninsured and underinsured Americans continues to rise: As of 2007, 42% of all working-age adults were either uninsured or underinsured–up from 35% in 2003.

In addition, the report said that the United States failed to keep up with improvements made in other countries, and fell from 15th place to dead last among 19 industrialized nations in premature deaths that could have been prevented by timely access to effective health care.

Rates for basic preventive care, such as cancer screening, failed to improve from 2005 to 2007, the report said.

In addition, “scores on efficiency are particularly low, pulled down by fragmented, poorly coordinated care,” along with lack of access to care and high administrative costs, said Cathy Schoen, senior vice president of The Commonwealth Fund.

In 2007, for example, as in 2005, patients in the United States were three to four times more likely than patients in other countries to report having had duplicate tests or to report that medical records or test results were not available at the time of their appointment. And, although primary care physicians in the United States used electronic medical records (EMRs) increasingly from 2001 to 2006–17% to 28%–the United States lags far behind leading countries, where EMRs now are used by nearly all physicians (98%) to improve care, the scorecard reported.

Still, “there are some bright spots,” Ms. Schoen said. The report found evidence that focusing on specific areas through targeted initiatives can yield substantial improvement.

For example, the report found that hospital standardized mortality ratios, a key indicator of patient safety, improved by 19% over 5 years, following broad public and private efforts to assess and improve hospital safety. Also, chronic care and acute hospital care quality metrics that have been the focus of public reporting, pay for performance, and improvement efforts also showed significant progress.

“We find that what gets attention gets improved,” Ms. Schoen said. “But to date we have focused too narrowly. Current initiatives often fail to encourage more effective or more efficient care.”

Dr. Davis pointed out that, with a new president and administration next year, the United States has a real opportunity to refocus and rebuild its health care system.

“The most important thing is extending health insurance to all,” she said. “There were 75 million American adults uninsured at some point in the year, and obviously that affects performance throughout the scorecard.”

Access to care has declined significantly since 2003, with 42% of all working-age adults either uninsured or underinsured in 2007, according to a national health system scorecard from The Commonwealth Fund, which found that health care system performance in the United States has worsened slightly overall since 2006.

According to the scorecard report, the United States on average continues to fall far short on key indicators of health outcomes and quality. U.S. scores are particularly low on efficiency, compared with top performers inside the country–states, regions, hospitals, health plans, or other providers–and internationally.

“These findings were very disturbing, considering the resources the U.S. spends on health care,” Dr. Karen Davis, president of The Commonwealth Fund, said in a briefing on the report, adding that the nation spends more on health care than any other in the industrialized world.

In the report, “Why Not the Best? Results From the National Scorecard on U.S. Health System Performance, 2008,” the United States scored an average of 65 out of a possible 100–slightly below the 67 scored in 2006 in the first scorecard released–across 37 key indicators of health outcomes, quality, access, efficiency, and equity.

“We need to change direction,” Dr. Davis said. “This latest scorecard demonstrates that we are in fact losing ground.”

The report found that the number of uninsured and underinsured Americans continues to rise: As of 2007, 42% of all working-age adults were either uninsured or underinsured–up from 35% in 2003.

In addition, the report said that the United States failed to keep up with improvements made in other countries, and fell from 15th place to dead last among 19 industrialized nations in premature deaths that could have been prevented by timely access to effective health care.

Rates for basic preventive care, such as cancer screening, failed to improve from 2005 to 2007, the report said.

In addition, “scores on efficiency are particularly low, pulled down by fragmented, poorly coordinated care,” along with lack of access to care and high administrative costs, said Cathy Schoen, senior vice president of The Commonwealth Fund.

In 2007, for example, as in 2005, patients in the United States were three to four times more likely than patients in other countries to report having had duplicate tests or to report that medical records or test results were not available at the time of their appointment. And, although primary care physicians in the United States used electronic medical records (EMRs) increasingly from 2001 to 2006–17% to 28%–the United States lags far behind leading countries, where EMRs now are used by nearly all physicians (98%) to improve care, the scorecard reported.

Still, “there are some bright spots,” Ms. Schoen said. The report found evidence that focusing on specific areas through targeted initiatives can yield substantial improvement.

For example, the report found that hospital standardized mortality ratios, a key indicator of patient safety, improved by 19% over 5 years, following broad public and private efforts to assess and improve hospital safety. Also, chronic care and acute hospital care quality metrics that have been the focus of public reporting, pay for performance, and improvement efforts also showed significant progress.

“We find that what gets attention gets improved,” Ms. Schoen said. “But to date we have focused too narrowly. Current initiatives often fail to encourage more effective or more efficient care.”

Dr. Davis pointed out that, with a new president and administration next year, the United States has a real opportunity to refocus and rebuild its health care system.

“The most important thing is extending health insurance to all,” she said. “There were 75 million American adults uninsured at some point in the year, and obviously that affects performance throughout the scorecard.”

Access to care has declined significantly since 2003, with 42% of all working-age adults either uninsured or underinsured in 2007, according to a national health system scorecard from The Commonwealth Fund, which found that health care system performance in the United States has worsened slightly overall since 2006.

According to the scorecard report, the United States on average continues to fall far short on key indicators of health outcomes and quality. U.S. scores are particularly low on efficiency, compared with top performers inside the country–states, regions, hospitals, health plans, or other providers–and internationally.

“These findings were very disturbing, considering the resources the U.S. spends on health care,” Dr. Karen Davis, president of The Commonwealth Fund, said in a briefing on the report, adding that the nation spends more on health care than any other in the industrialized world.

In the report, “Why Not the Best? Results From the National Scorecard on U.S. Health System Performance, 2008,” the United States scored an average of 65 out of a possible 100–slightly below the 67 scored in 2006 in the first scorecard released–across 37 key indicators of health outcomes, quality, access, efficiency, and equity.

“We need to change direction,” Dr. Davis said. “This latest scorecard demonstrates that we are in fact losing ground.”

The report found that the number of uninsured and underinsured Americans continues to rise: As of 2007, 42% of all working-age adults were either uninsured or underinsured–up from 35% in 2003.

In addition, the report said that the United States failed to keep up with improvements made in other countries, and fell from 15th place to dead last among 19 industrialized nations in premature deaths that could have been prevented by timely access to effective health care.

Rates for basic preventive care, such as cancer screening, failed to improve from 2005 to 2007, the report said.

In addition, “scores on efficiency are particularly low, pulled down by fragmented, poorly coordinated care,” along with lack of access to care and high administrative costs, said Cathy Schoen, senior vice president of The Commonwealth Fund.

In 2007, for example, as in 2005, patients in the United States were three to four times more likely than patients in other countries to report having had duplicate tests or to report that medical records or test results were not available at the time of their appointment. And, although primary care physicians in the United States used electronic medical records (EMRs) increasingly from 2001 to 2006–17% to 28%–the United States lags far behind leading countries, where EMRs now are used by nearly all physicians (98%) to improve care, the scorecard reported.

Still, “there are some bright spots,” Ms. Schoen said. The report found evidence that focusing on specific areas through targeted initiatives can yield substantial improvement.

For example, the report found that hospital standardized mortality ratios, a key indicator of patient safety, improved by 19% over 5 years, following broad public and private efforts to assess and improve hospital safety. Also, chronic care and acute hospital care quality metrics that have been the focus of public reporting, pay for performance, and improvement efforts also showed significant progress.

“We find that what gets attention gets improved,” Ms. Schoen said. “But to date we have focused too narrowly. Current initiatives often fail to encourage more effective or more efficient care.”

Dr. Davis pointed out that, with a new president and administration next year, the United States has a real opportunity to refocus and rebuild its health care system.

“The most important thing is extending health insurance to all,” she said. “There were 75 million American adults uninsured at some point in the year, and obviously that affects performance throughout the scorecard.”