'Lucky' seven times four.

No, we’re not making odds for a horse race or betting at a table in Las Vegas! Readers of my column in P&T might recall my discussions of our nation’s performance in health care in previous issues. I’ve noted, with disappointment, that our health care system does not perform as well as those in other nations we like to compare ourselves with. A report from the Commonwealth Fund that caught my attention this past summer has added even more stark survey data that make the comparisons more striking.1 The most recent report, from 2010, is the fourth in a series. In all of the previous reports, dating back to 2004, the U.S. ranked last (seventh)—hence the ironic expression “lucky” seven times four. How are these rankings developed and assigned? A great deal of work has gone into this assessment, which updates reports over the previous seven years. The newest report includes responses collected from surveys of physicians, patients, and other key stakeholders. The report also relies heavily on national measures of quality from organizations as varied as the National Committee on Quality Assurance (NCQA) to Medicare. Data from the Organization of Economic Cooperation and Development are also collated. No matter how one slices and dices the information or evaluates the survey scores, it is clear that the U.S. finished last each time in all categories. In addition, the cost of health care in the U.S. is more expensive than in the other six nations (The Netherlands, New Zealand, Canada, Germany, the United Kingdom, and Australia). How was this substandard and perplexing result obtained? The Commonwealth Fund, with headquarters in New York City, is a private foundation that promotes a high-performance health care system that strives to provide improved access to care, quality of care, and efficiency. Its work focuses primarily on society’s most vulnerable, including low-income residents, the un insured, minorities, young children, and older adults. The Fund carries out this mandate by supporting independent research and making grants to improve health care practice and policy. An international program is designed to stimulate innovative policies and practices in the U.S. and other industrialized countries.1 What are some of the key findings? The four indicators of quality included effective care, safe care, coordinated care, and patient-centered care. Compared with the other six countries, the U.S. fared best in providing preventive and patient-centered care, but its low ratings in chronic care management, safe care, and coordinated care reduced its overall quality score.