MONDAY, Oct. 3, 2005 (HealthDay News) -- The U.S. health-care system is fraught with waste and inefficiency, unequal access, and stubborn gaps in quality and coverage, but it also offers opportunities for improvement, according to a new report.

The report, released Monday in Washington, D.C., was prepared by the Commonwealth Fund's Commission on a High Performance Health System, a panel formed in June by the fund to offer system-wide reforms. The report sets the stage for the commission's upcoming work, officials said.

"Essentially the commission is to identify public and private strategies, policies and practices that will lead to improvements in the delivery and financing of care for all Americans," said Anne Gauthier, the panel's senior policy director.

It's a lofty goal, she admitted, one that commission members don't take lightly.

"Many of us have been working at health-care reform for a number of years," Gauthier noted, "and yet we have not made the progress that we might all have hoped we'd have made by now. And (we) think that some bold steps are going to need to be taken."

Access to care remains one of the nation's most intractable health-care problems, the report suggested. Some 45.8 million Americans lack health insurance coverage, and that number is projected to exceed 50 million by the end of the decade.

Other key points from the report:

  • Though the U.S. spends more than twice as much on health care per capita as other industrialized nations, Americans don't live as long as people in some industrialized countries.
  • Between 1987 and 2003, the working middle class saw the greatest increase in uninsured individuals.
  • Of uninsured adults, 61 percent reported problems filling prescriptions, seeing a specialist, receiving a treatment or medical test, or even seeking advice on a medical problem.
  • Those with no insurance, sporadic coverage, or insurance that exposes them to catastrophic out-of-pocket costs are more likely to go without care.

In a commentary posted on the Commonwealth Fund's Web site, Commission Chairman Dr. James J. Mongan, president and CEO of Partners HealthCare in Boston, said that additional taxes or employer mandates will be needed to finance expanded coverage, an idea that is likely to face continued resistance.

"Progress in the struggle to finance universal coverage will not come easily and will be bitterly fought at every step," he wrote. "I believe progress on health insurance will come only when we as a nation answer the question of what happened to social justice as a moral value."

But Devon M. Herrick, a senior fellow at the National Center for Policy Analysis, said part of the problem is that public-health advocates and health economists "can't even agree on what the problem is."

Having studied the latest U.S. Census Bureau data on the uninsured, for example, Herrick found that roughly one-third live in households with more than $50,000 in annual income, many of whom could presumably afford some type of health insurance coverage, he said. In addition, some 10 million to 12 million people already qualify for Medicaid or the State Children's Health Insurance Program but are not enrolled. It's likely those people would seek enrollment after suffering an illness or injury requiring coverage, he said.

A lack of consensus on how to fix the health-care system's ills also remains, Herrick noted.

"Whereas economists would tend to want to pull it toward a free market, public health advocates tend to want to pull it the other direction more toward a controlled market," he said.

In hopes of moving the discussion along, the commission is developing a "scorecard," due out next spring, to measure health-system performance against five-, 10- and 15-year targets for improvement, Gauthier said. In addition, the panel will try to identify promising innovations at the policy and delivery system levels.

"Despite the fact that we have an awful lot that's excellent in the United States," she said, "we compare poorly, frankly, against other developed countries along so many measures that there's a real imperative to make some change."

More information

Visit the Commonwealth Fund to read the report and commentary.

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