Overview

The U.S. health care system falls short on several dimensions of performance. The fragmented nature of the system—with multiple public and private financing and delivery processes, as well as numerous entities responsible for controlling costs and ensuring quality, safety, and access—poses many barriers to high performance. Several potential levers available to private and public stakeholders could promote reform. In particular, the federal government might consider helping to restructure the health care market so it functions more effectively and efficiently; for example, by investing in research and evaluation to determine best practice and funding technical assistance to spread innovation. Rather than addressing coverage, quality, and cost as separate issues, it might be time to consider them simultaneously. It is also important to consider how proposed public policies would affect each of the dimensions of health system performance.

Introduction

Although Americans have long believed they receive the best health care in the world, evidence shows that there is room for improvement across many dimensions of health system performance. There are concerns about the absolute and relative cost and quality of care, as well as about the far too many people in the United States lacking access to affordable health insurance and needed care. At the same time, some states and localities are achieving much higher performance on coverage, access, quality, and efficiency than the nationwide average. The challenge, given competing interests and incentives as well as enormous complexity in the financing, delivery, and organization of health care, is how to move the nation in the right direction and effect change at a far faster pace.

In this report, we illustrate how the U.S. health care system fails to perform sufficiently well across 10 dimensions of high performance: providing for long, healthy, and productive lives; getting the right care; safe care; coordinated care; excellent care and service from the patient's perspective; universal participation; equity; efficiency; affordability; and the capacity to improve. We describe the unique features of the U.S. health care system and illustrate how it constructs roadblocks on the path toward high performance. Finally, we explore potential levers that might be used to accelerate improvement and suggest near-term roles for the federal government.

Citation