Chartpack 2008 PDF

8/12/2019 Chartpack 2008 PDF

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JULY 2008

COMMISSION ON A HIGH PERFORMANCE HEALTH SYSTEM

ONE EAST 75TH STREET

NEW YORK, NY 10021-2692

TEL 212.606.3800

FAX 212.606.3500

www.commonwealthfund.org

National Scorecard on

U.S. Health System Performance, 2008

Chartpack


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This Chartpack presents data forall indicators scored in theNational Scorecard on U.S. HealthSystem Performance, 2008. Charts

display average performancefor the U.S. as a whole and therange of performance foundwithin the U.S or compared withother countries.

The charts accompany theCommissions July 2008 report,Why Not the Best? Results from aNational Scorecard on U.S. Health

System Performance, 2008.


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Scores: Dimensions of a High Performance Health System

75

72

67

52

70

67

72

71

58

53

71

65

0 100

Healthy Lives

Quality

Access

Efficiency

Equity

OVERALL SCORE

2006 Revised

2008

Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008 2

HEALTHY LIVES

SECTION 1. HEALTHY LIVES

Scored Indicators:

1. Mortality amenable to health care

2. Infant mortality rate

3. Healthy life expectancy at age 60*

4. Adults under 65 limited in any activities because of health problems

5. Children who missed 11 or more days of school due to illness orinjury*

* Indicator was not updated due to lack of data. Baseline figures from 2006 Scorecard are presented.



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7681

8884

89 89

99 9788

97

109 106

116 115 113

130 134

128

115

65 71 71 74 74 77 80

82 82 84 84 90 93 96

101 103 103 104 110

0

50

100

150

France

Japan

Australia

Spain

Italy

Canada

Norway

Netherlands

Sweden

Greece

Austria

Germany

Finland

New

Zealan

Denmark

United

Kingdo

Ireland

Portugal

United

States

1997/98 2002/03

Deaths per 100,000 population*

* Countries age-standardized death rates before age 75; including ischemic heart disease, diabetes, stroke, and bacterial infections.

See report Appendix B for list of all conditions considered amenable to health care in the analysis.

Data: E. Nolte and C. M. McKee, London School of Hygiene and Tropical Medicine analysis of World Health Organization mortality

files (Nolte and McKee 2008).

Mortality Amenable to Health Care

HEALTHY LIVES


7.2 7.0 6.9 6.8 7.0 6.8 6.8

10.3

11.1

10.2 9.9 9.9 9.610.1

5.3 5.1 5.0 4.9 4.8 4.7 4.7

0

4

8

12

1998 1999 2000 2001 2002 2003 2004

U.S. average Bottom 10% states Top 10% states

National Average and State Distribution International Comparison, 2004

2.8 2.8 3.1 3.2 3.3

4.4

5.3

6.8

Japan

Icelan

d

Sweden

Norway

Finlan

d

Denm

ark

Canada U.S

.


Infant Mortality Rate

Infant deaths per 1,000 live births

^ Denotes baseline year.

Data: National and stateNational Vital Statistics System, Linked Birth and Infant Death Data (AHRQ 2003, 2004, 2005,

2006, 2007a); international comparisonOECD Health Data 2007, Version 10/2007.

HEALTHY LIVES


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Healthy Life Expectancy at Age 60, 2002

222020 2020 201919 19 1919191919 1818 18 18 18181817 1718 17 1716 1717 161616 1616 16

181616 16 1616 1515 1515

14

0

10

20

30

Japan

Switz

erlan

FranceSp

ain

Sweden

Australia Ita

ly

Austria

Cana

da

Belgium

Germ

any

Norw

ay

Iceland

Finland

Netherlan

ds

NewZe

alan

Greece

Unite

dKing

do

Unite

dStates

Portu

gal

Irelan

d

Denm

ark

CzechRepubli

Women Men

Years

Note: Indicator was not updated due to lack of data. Baseline figures are presented.

Data: The World Health Report 2003 (WHO 2003, Annex Table 4).

Developed by the World Health Organization, healthy life expectancy is based on

life expectancy adjusted for time spent in poor health due to disease and/or injury


HEALTHY LIVES

Working-Age Adults with Health Limits on Activities or Work

Data: D. Belloff, Rutgers Center for State Health Policy analysis of Behavioral Risk Factor Surveillance System.

7

Percent of adults (ages 1864) limited in any activities because of physical,mental, or emotional problems

8.3

13.4

24.2

10.3

15.4

27.4

Age 1829 Age 3049 Age 5064

2004 2006

14.9

11.5

20.1

17.5

13.2

23.4

0

10

20

30

40

U.S. Average Top 10% States Bottom 10%

States

2004 2006


National Average and State Distribution By Age Group

HEALTHY LIVES


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Note: Indicator was not updated due to lack of data. Baseline figures from Scorecard 2006 are presented.

Data: 2003 National Survey of Childrens Health (HRSA 2005; retrieved f rom Data Resource Center for Child and Adolescent

Health database at http://www.nschdata.org).

Percent of children (ages 617) who missed 11 or more school daysdue to illness or injury during past year

School Absences Due to Illness or Injury, by Top and Bottom States,Race/Ethnicity, Family Income, and Insurance, 2003

4.7

4.2

3.6

4.8

5.5

8.1

3.8

5.2

8.0

4.2

0 5 10

Uninsured

Private insurance


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Effective Care

Scored Indicators:

1. Adults received recommended screening and preventive care

2. Children received recommended immunizations and preventive care

Received all recommended doses of five key vaccines

Received both medical and dental preventive care visits*

3. Needed mental health care and received treatment

Adults

Children*

4. Chronic disease under control

Adults with diabetes whose HbA1c level


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Immunizations for Young Children

^ Denotes baseline year.

* Recommended vaccines include: 4 doses of diphtheria-tetanus-pertussis (DTP), 3+ doses of polio, 1+ dose of measles-mumps-

rubella, 3+doses of Haemophilus influenzae type B, and 3+ doses of hepatitis B vaccine. **Data by insurance was from 2003.

Data: National Immunization Survey (NCHS National Immunization Program, Allred 2007).

Percent of children (ages 1935 months) who received all recommended doses of five key vaccines*

73 74 7579 81 81 81

82 80 84

89 88 88 86

66 66 65

71 72 71 72

0

25

50

75

100

2000 2001 2002 2003 2004 2005 2006

U.S. average Top 10% states Bottom 10% states

QUALITY: EFFECTIVE CARE

By Family Income, Insurance Status**,and Race/Ethnicity, 2006

71

75

83

82

77

80

77

82

0 25 50 75 100

Uninsured all year

Insured part year

Insured all year

100%+ of poverty


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50

87

80

52

69

60

71

73

65

0 20 40 60 80 100

Uninsured

Medicare**

Medicaid

Private

Hispanic

Black

White

2006

2004


Adults with Major Depressive Episode Who Received Treatment

U.S. Variation 2006

U.S. Average


Percent of adults (ages 18+) with major depressive episode who received

treatment in the past year*

Note: Indicator definition has been modified from 2006 Scorecard.

*Major depressive episode is defined as a period of at least 2 weeks when a person experienced a depressed mood or loss of

interest or pleasure in daily activities and had a majority of the symptoms for depression. **Medicare includes other insurance such

as military and veterans health care.

Data: National Survey on Drug Use and Health (SAMHSA 2006 and 2007).

Note: Indicator was not updated due to lack of data. Baseline figures are presented.

* Children with current emotional, developmental, or behavioral health condition requiring treatment or counseling who received

needed care during the year.Data: 2003 National Survey of Childrens Health (HRSA 2005; Retrieved f rom Data Resource Center for Child and Adolescent

Health database at http://www.nschdata.org).

Percent of children (ages


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Chronic Disease Under Control: Diabetes and Hypertension

81

41

63

21

Diabetes under

control*

High blood pressure

under control**

Insured Uninsured

*Refers to diabetic adults whose HbA1c is


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9691

87

99 9895

88

7176

Heart Attack Heart Failure Pneumonia

Median 90th %ile 10th %ile

84

99

91

75

90

10096

78

0

25

50

75

100

Median Best 90th %ile 10th %ile

2004 2006

Overall Composite for All Three Conditions


Hospitals: Quality of Care for Heart Attack, Heart Failure,and Pneumonia

* Composite for heart attack care consists of 5 indicators; heart failure care, 2 indicators; and pneumonia care, 3 indicators.

Overall composite consists of all 10 clinical indicators. See report Appendix B for description of clinical indicators.

Data: A. Jha and A. Epstein, Harvard School of Public Health analysis of data from CMS Hospital Compare.

Percent of patients who received recommendedcare for all three conditions*

Individual Composites by Condition, 2006

Percent of patients who received recommendedcare for each condition*


87

74

91 89

82

94100

0

25

50

75

100

Median Best 90th %ile 10th %ile Best 90th %ile 10th %ile

Percent of patients who received recommended care for all three conditions

Hospital Quality of Care for Heart Attack, Heart Failure, and Pneumonia:

Overall Composite Using Expanded Set of 19 Clinical Indicators*, 2006

*Consists of original 10 "starter set" indicators and 9 new indicators for which data was made available as of December 2006;

heart attack care includes 3 new indicators; heart failure care, 2 new indicators; and pneumonia, 4 new indicators)


Hospitals States




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Hospital Quality of Care by Condition: Composites for Heart Attack,Heart Failure, and Pneumonia

6983

7991

8292

6676

8895

99100

7887

(Original: 3 indicators)

20042006

758790619510083(Expanded: 4 indicators*) 2006


Pneumonia

Heart failure

Acute myocardial infarction


STATESHOSPITALS

79

81

89

93

91

94

62

71

94

98

100

100

83

91


2004

2006

89

93

96

97

97

98

80

88

98

99

100

100

92

96


2004

2006

10thpercentile

90thpercentile

Best10th

percentile90th

percentileBestMedian

Percent of patients who received

recommended care:

20Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2008 20


*Consists of original "starter set" indicators and new indicators for which data was made available as of December 2006.


Coordinated Care

Scored Indicators:

1. Adults under 65 with an accessible primary care provider

2. Children with a medical home*

3. Care coordination at hospital discharge

Hospitalized patients with new Rx: Medications were reviewedat discharge*

Heart failure patients received written instructions at discharge

Follow-up within 30 days after hospitalization for mental healthdisorder

4. Nursing homes: hospital admissions and readmissions

5. Home health: hospital admissions

QUALITY: COORDINATED CARE




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37

51

74

63

69

65

66

49

53

73

59

0 20 40 60 80 100

Uninsured all year

Uninsured part year

Insured all year


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86

7773 72

69 67

0

25

50

75

100

GER AUS UK CAN NZ US

Percent of hospitalized patients with new prescription who reportedprior medications were reviewed at discharge

Medications Reviewed When Discharged from the Hospital,Among Sicker Adults, 2005

Note: Indicator was not updated due to lack of data. Baseline figures from Scorecard 2006 are presented.

AUS=Australia; CAN=Canada; GER=Germany; NZ=New Zealand; UK=United Kingdom; US=United States.

Data: 2005 Commonwealth Fund International Health Policy Survey.



50

87

9

49

61

33

68 69

80

56

36

94

0

25

50

75

100

U.S. mean 90th %ile 10th %ile Median 90th %ile 10th %ile

2004 2006

Percent of heart failure patients discharged home with written instructions*

Heart Failure Patients Given Complete Written Instructions WhenDischarged, by Hospitals and States


* Discharge instructions must address all of the following: activity level, diet, discharge medications, follow-up appointment,

weight monitoring, and what to do if symptoms worsen.

Data: A. Jha and A. Epstein, Harvard School of Public Health analysis of data from CMS Hospital Compare;

State 2004 distribution Retrieved from CMS Hospital Compare database at http://www.hospitalcompare.hhs.gov.

Hospitals States



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Home Health Care: Hospital Admissions

28

17

47

20

35

28

19

48

20

37

0

20

40

60

Mean Top 25% Bottom 25% Top 10% Bottom 10%

2003-2004^ 2006-2007

^ 2003 data for state estimates.

Data: Outcome and Assessment Information Set (Retrieved from CMS Home Health Compare database at

http://www.medicare.gov/HHCompare, Pace et al. 2005)

Percent of home health care patients who had to be admitted to the hospital



Home Health Agencies States

Safe CareScored Indicators:

1. Patients reported medical, medication, or lab test error

2. Unsafe drug use

Ambulatory care visits for treating adverse drug effects

Children prescribed antibiotics for throat infection withouta strep test

Elderly used 1 of 33 inappropriate drugs

3. Nursing home residents with pressure sores

4. Hospital-standardized mortality ratios

Other Indicators:

1. Surgical infection prevention

2. Adverse events and complications of care in hospitals

QUALITY: SAFE CARE



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Medical, Medication, and Lab Errors, Among Sicker Adults

3432

1921 22

2628

30

0

10

20

30

40

GER NETH UK NZ CAN AUS

International Comparison

AUS=Australia; CAN=Canada; GER=Germany; NETH=Netherlands; NZ=New Zealand; UK=United Kingdom.

Data: 2005 and 2007 Commonwealth Fund International Health Policy Survey.

EXHIBIT 16

2005 2007

United States

QUALITY: SAFE CARE

Percent reporting medical mistake, medication error, or lab error in past two years


Ambulatory Care Visits for Treating Adverse Drug Effects

20

22

18

21

17

9

28

1716

22

0

10

20

30

Total

Male

Fema

leWh

iteBl

ack

Othe

r

North

eas

Midw

est

Sout

hW

est

* Denotes baseline year.Data: C. Zhan, AHRQ analysis of National Ambulatory Medical Care Survey and National Hospital Ambulatory

Medical Care Survey.

Visits per 1,000 population per year

QUALITY: SAFE CARE


11.3

12.9

15.3

11.3

17.4

19.8

1999 2000 2001* 2002 2003 2004

Total

Physician Office

Hospital Emergency Department Visits

Hospital Outpatient Department Visits

By Gender, Race, and Region, 2004 Annual Averages, by Care Setting


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Pressure Sores Among High-Risk and Short-Stay Residentsin Nursing Facilities

13

8

18

13

7

17

0

10

20

30

U.S. average Top 10% states Bottom 10%

states

2004 2006

Percent of nursing home residents with pressure sores

19

14

24

17

12

23

U.S. average Top 10% states Bottom 10%

states

2004 2006

High-Risk Residents Short-Stay Residents

Data: Nursing Home Minimum Data Set (AHRQ 2005, 2007a).

QUALITY: SAFE CARE


Hospital-Standardized Mortality Ratios

101

8593 94

97 100 103 106 106

112 118

8274

78 78 79 81 83 83 85 86

89

0

20

40

60

80

100

120

140

U.S. 1 2 3 4 5 6 7 8 9 10

2000-2002 2004-2006

Ratio of actual to expected deaths in each decile (x 100)

Decile of hospitals ranked by actual to expected deaths ratios

Standardized ratios compare actual to expected deaths, risk-adjusted forpatient mix and community factors.* Medicare national average for 2000=100

QUALITY: SAFE CARE

mean

* See report Appendix B for methodology.

Data: B. Jarman analysis of Medicare discharges from 2000 to 2002 and from 2004 to 2006 for conditions leading to 80 percent of

all hospital deaths.



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80

60

90 87

73

92

100

0

25

50

75

100

Median Best 90th %ile 10th %ile Best 90th %ile 10th %ile

Surgical Infection Prevention, 2006

Hospitals States


QUALITY: SAFE CARE

Percent of surgical patients who received appropriate timing of antibiotics

to prevent infections*

* Comprised of two indicators: antibiotics started within 1 hour before surgery and stopped 24 hours after surgery.


Nosocomial Infections in Intensive Care Unit Patients, 2006

9.54.11.70.00.036Neonatal (NICU)(infants weighing 750 grams or less)

10.06.44.11.80.061Surgical

6.23.81.60.00.099Medical-surgicalall others

7.35.12.51.30.058Medical-surgicalmajor teaching

7.24.62.80.90.064Medical

955No. of unitsType of ICUPercentile

Ventilator-associated pneumoniarate, per 1,000 days use

15.611.05.22.50.042NeonatalLevel III(infants weighing 750 grams or less)

7.44.42.00.90.072Surgical

4.52.31.00.00.0102Medical-surgicalall others

5.53.11.90.60.063Medical-surgicalmajor teaching

6.24.22.20.00.073Medical

955No. of unitsType of ICUPercentile

Central line-associated bloodstreaminfection rate, per 1,000 days use

Data: Reported by 211 hospitals participating in the National Healthcare Safety Network (Edwards et al. 2007).

37

QUALITY: SAFE CARE



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Potentially Preventable Adverse Events and Complicationsof Care in Hospitals, National and Medicare Trends

25

16

34

48

53

82

131

105

98

89

276

261

2004

25

16

34

47

50

86

120

92

92

86

267

248

2003

Accidental puncture or laceration

NA474438National

35363231Medicare

NA151412National

15242020Medicare

Infection due to medical care

59463425Medicare

NA807263National

Postoperative respiratory failure

1211119780Medicare

NA928163National

Postoperative sepsis

100867162Medicare

NA796658National

Postoperative pulmonary embolismor deep vein thrombosis

282251225206Medicare

NA236221195National

Decubitus ulcer (pressure sore)

2005200220001997/1998**Risk-adjusted rate per 10,000discharges*

* Rates exclude complications present on admission and are adjusted for gender, comorbidities,

and diagnosis-related group clusters. ** National rate is for 1997, Medicare rate is for 1998. NA=data not available.

Data: National figuresHealthcare Cost and Utilization Project, Nationwide Inpatient Sample (retrieved from HCUPNet at

http://hcupnet.ahrq.gov); Medicare figuresMedPAC analysis of Medicare administrative data using AHRQ indicators andmethods (MedPAC 2005, Chart 3-3 and 2007, Chart 4-2).

38

QUALITY: SAFE CARE


Potentially Preventable Adverse Events and Complications

of Care in Hospitals Among Medicare Beneficiaries, 20042005

2.4

9.8

4.6

1.9

8.8

3.63.6

10.6

6.0

0

5

10

15

Postoperative

complications composite*

Adverse drug events

composite**

Pressure sores

US Average Top 10% States Bottom 10% States

Percent


QUALITY: SAFE CARE

*Surgical patients with postoperative pneumonia, urinary tract infection (2005 only), or venous thromboembolic event

** Patients with serious bleeding associated with intravenous heparin, low molecular weight heparin, or warfarin, or hypoglycemia

associated with insulin or oral hypoglycemics.

Data: M. Pineau, Qualidigm analysis of Medicare Patient Safety Monitoring System.


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Patient-Centered, Timely Care

Scored Indicators:

1. Ability to see doctor on same/next day when sick or need medicalattention

2. Very/somewhat easy to get care after hours without going to theemergency room

3. Doctorpatient communication: always listened, explained, showedrespect, spent enough time

4. Adults with chronic conditions given self-management plan*

5. Patient-centered hospital care

Other Indicator:

1. Physical restraints in nursing homes

QUALITY: PATIENT-CENTERED, TIMELY CARE



Waiting Time to See Doctor When Sick or Need Medical Attention,Among Sicker Adults

47 46

7469

6358 57

32

0

25

50

75

100

NZ NETH GER AUS UK CAN




EXHIBIT 16

2005 2007

United States


Percent of adults who could get an appointment on the same or next day



25/572

Difficulty Getting Care on Nights, Weekends, Holidays WithoutGoing to the Emergency Room, Among Sicker Adults

61

73

48 49 50

6168 69

0

25

50

75

100

NETH NZ GER UK AUS CAN



Percent of adults who sought care reporting very or somewhat difficult



2005 2007

United States


DoctorPatient Communication: Doctor Listened Carefully,

Explained Things, Showed Respect, and Spent Enough Time,National and Managed Care Plan Type

70 7067

75 74 73

65 6359

Private Medicare** Medicaid

Mean 90th %ile 10th %ile

43

Percent of adults (ages 18+) reporting always

Managed Care Plan Distribution, 2006

* Denotes baseline year. **2005 data due to delays in the Medicare CAHPS survey.

Data: National averageMedical Expenditure Panel Survey (AHRQ 2005, 2006, 2007a); Plan distributionCAHPS (data provided

by NCQA).

54 57 57

0

25

50

75

100

2002* 2003 2004

National Average




26/572

65

58 5650

45

37

0

25

50

75

100

CAN US NZ AUS UK GER

Adults with Chronic Conditions: Receipt of Self-Management Plan,Among Sicker Adults, 2005

Note: Indicator was not updated due to lack of data. Baseline figures are presented.* Adult reported at least one of six conditions: hypertension, heart disease, diabetes, arthritis, lung problems (asthma, emphysema,

etc.), or depression.

AUS=Australia; CAN=Canada; GER=Germany; NZ=New Zealand; UK=United Kingdom; US=United States.


Percent of adults with chronic conditions* whose doctor gave plan to manage care at home



Patient-Centered Hospital Care: Staff Managed Pain, RespondedWhen Needed Help, and Explained Medicines, by Hospitals, 2007

6760 58

9791

96

75 7266

60

48 49

0

25

50

75

100

Staff managed pain well Staff responded when needed

help

Staff explained medicines and

side effects

Mean Best hospital 90th %ile hospitals 10th %ile hospitals

Percent of patients reporting always

* Patients pain was well controlled and hospital staff did everything to help with pain.

** Patient got help as soon as wanted after patient pressed call button and in getting to the bathroom/using bedpan.

*** Hospital staff told patient what medicine was for and described possible side effects in a way that patient could understand.

Data: CAHPS Hospital Survey (Retrieved from CMS Hospital Compare database at http://www.hospitalcompare.hhs.gov).

*** ***

45




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Physical Restraints in Nursing Facilities

9.7

8.07.4

6.85.9

18.4

3.72.6

2.4 2.2 1.9

11.7

13.214.1

14.7

0

5

10

15

20

2002 2003 2004 2005 2006

U.S. average Bottom 10% states Top 10% states

PI=Pacific Islander; AI/AN=American Indian or Alaskan Native.

Data: Nursing Home Minimum Data Set (AHRQ 2004, 2005, 2006, 2007a).

7.86.9

10.7 10.2

7.66.6

5.8

8.79.8

7.7

White Black Hispanic Asian/PI AI/AN

2003 2005

By Race/Ethnicity



Percent of nursing home residents who were physically restrained

National Average and State Distribution

SECTION 3. ACCESS

Access includes indicators organized into two groups:

1. Participation

2. Affordability

The Scorecard scores each group of indicators separately, and thenaverages the two scores to create the overall score for Access.

ACCESS



28/572

Participation

Scored Indicators:

1. Adults under 65 insured all year, not underinsured

2. Adults with no access problem due to costs

Other Indicator:

1. Uninsured under 65: national and state trends

ACCESS: PARTICIPATION


Uninsured and Underinsured Adults, 2007 Compared with 2003


Total 200% of poverty or moreUnder 200% of poverty

* Underinsured defined as insured all year but experienced one of the following: medical expenses equaled 10% or more of income,

or 5% or more of income if low-income (


29/572

Access Problems Because of Costs

4037

58

12

21

25 26

0

25

50

NETH UK CAN GER NZ AUS


* Did not get medical care because of cost of doctors visit, skipped medical test, treatment, or follow-up because of cost, or did

not fill Rx or skipped doses because of cost.



EXHIBIT 16

2005 2007

United States


Percent of adults who had any of three access problems* in past year because of costs


5 8

12

2125 26

37

0

25

50

75

NETH UK CAN GER NZ AUS US

6 9

18

24

32 30

52

3

8 7

1822 21

25

NETH UK CAN GER AUS NZ US

Below average income Above average income

51

* Did not get medical care because of cost of doctors visit, skipped medical test, treatment, or follow-up because of cost, or did

not fill Rx or skipped doses because of cost.

AUS=Australia; CAN=Canada; GER=Germany; NETH=Netherlands; NZ=New Zealand; UK=United Kingdom; US=United States.



Access Problems Because of Costs, By Income, 2007

Percent of adults who had any of three access problems* in past year because of costs



30/572

Data: Two-year averages 19992000, updated with 2007 Current Population Survey correction, and 20052006 from the

Census Bureaus March 2000, 2001 and 2006, 2007 CPS.

WA

OR

ID

MT ND

WY

NV

CA

UT

AZ NM

KS

NE

MN

MO

WI

TX

IA

ILIN

AR

LA

AL

SC

TNNC

KY

FL

VA

OH

MI

WV

PA

NY

AK

MD

MEVT

NH

MA

RI

CT

DE

DC

HI

CO

GAMS

OK

NJ

SD

WA

OR

ID

MT ND

WY

NV

CA

UT

AZ NM

KS

NE

MN

MO

WI

TX

IA

ILIN

AR

LA

AL

SC

TNNC

KY

FL

VA

OH

MI

WV

PA

NY

AK

ME

DE

DC

HI

CO

GAMS

OK

NJ

SD

19%22.9%

Less than 14%

14%18.9%

23% or more

19992000 20052006

MA

RI

CT

VTNH

MD

Percent of Adults Ages 1864 Uninsured by State



Data: Two-year averages 19992000, updated with 2007 Current Population Survey correction, and 20052006 from the

Census Bureaus March 2000, 2001 and 2006, 2007 CPS.

WA

OR

ID

MT ND

WY

NV

CA

UT

AZ NM

KS

NE

MN

MO

WI

TX

IA

ILIN

AR

LA

AL

SC

TNNC

KY

FL

VA

OH

MI

WV

PA

NY

AK

MD

MEVT

NH

MA

RI

CT

DE

DC

HI

CO

GAMS

OK

NJ

SD

WA

OR

ID

MT ND

WY

NV

CA

UT

AZ NM

KS

NE

MN

MO

WI

TX

IA

ILIN

AR

LA

AL

SC

TNNC

KY

FL

VA

OH

MI

WV

PA

NY

AK

ME

DE

DC

HI

CO

GAMS

OK

NJ

SD

10%15.9%

Less than 7%

7%9.9%

16% or more

19992000 20052006

MA

RI

CT

VTNH

MD

Percent of Children Ages 017 Uninsured by State




31/572

Population Under Age 65 Without Health Insurance

17

12

16

20

12

18

0

10

20

30

All under 65 Children under 18 Adults 1864

2000 2006

Percent uninsured

9 8 8 8 8 8 8 9

29 30 31 34 35 35 36

38

0

20

40

60

1999 2000 2001 2002 2003 2004 2005 2006

Adults 1864

Children under 18

Millions uninsured

38 3839

4243

47

43

Data: Analysis of Current Population Survey, March 19952007 supplements. Updated data from March 2007 Current Population

Survey.

44



Affordable Care

Scored Indicators:

1. Families spending less than 10% of income or less than 5% ofincome, if low-income, on out-of-pocket medical costs and premiums

2. Population under 65 living in states where premiums foremployer-sponsored health coverage are less than 15% of under-65median household income

3. Adults under 65 with no medical bill problems or medical debt

Other Indicator:

1. Health insurance premium trends compared with workers earningsand overall inflation

ACCESS: AFFORDABLE CARE



32/572

Families with High Medical and Premium Costs Compared with Income,by Family Income

19

4442

15

5

16

40

29

23

44 42

21

8

20

50

27

0

20

40

60

Total Poor* Low income* Middle

income*

High

income*

Private

employer

Private

nongroup

Public

2001 2005

Percent of nonelderly population with high out-of-pocket

medical costs and premiums relative to income^

^High out-of-pocket costs defined as having combined out-of-pocket expenses for services and premiums greater than 5 percent

for persons in families with incomes less than 200% of poverty, and out-of-pocket expenses greater than 10 percent for persons in

families with incomes of 200% of poverty or higher.* Poor refers to household incomes


33/572

33

45

29

6168

56

Total Under 200% of

poverty

200% of poverty or

more

Insured all year Uninsured during year

34

41

0

25

50

75

100

2005 2007

Medical Bill Problems or Medical Debt

By Income and Insurance Status, 2007National Average

Percent of adults (ages 1964) with any medical bill problem or outstanding debt*

ACCESS: AFFORDABLE CARE

* Problems paying or unable to pay medical bills, contacted by a collection agency for medical bills, had to change

way of life to pay bills, or has medical debt being paid off over time.Data: 2005 and 2007 Commonwealth Fund Biennial Health Insurance Survey.


*Estimate is statistically different from the previous year shown at p


34/573

SECTION 4. EFFICIENCY

Scored Indicators:

1. Potential overuse or waste Duplicate medical tests Tests results or records not available at time of appointment Received imaging study for acute low back pain with no risk factors

2. ER use for condition that could have been treated by regular doctor

3. Hospital admissions for ambulatory caresensitive (ACS) conditions National ACS admissions: Heart failure, diabetes, pediatric asthma Medicare ACS admissions

4. Medicare hospital 30-day readmission rates

5. Medicare costs of care and mortality for heart attacks, hip fractures, orcolon cancer

6. Medicare costs of care for chronic diseases: diabetes, heart failure, COPD7. Health insurance administration as percent of total national health

expenditures

8. Physicians using electronic medical records

EFFICIENCY


International Comparison of Spending on Health, 19802005

$-

$1,000

$2,000

$3,000

$4,000

$5,000

$6,000

$7,000

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

United States

GermanyCanada

FranceAustraliaUnited Kingdom

0

2

4

6

8

10

12

14

16

1980

1982

1984

1986

1988

1990

1992

1994

1996

1998

2000

2002

2004

United States

GermanyCanada

FranceAustralia

United Kingdom

* PPP=Purchasing Power Parity.

Data: OECD Health Data 2007, Version 10/2007.

Average spending on healthper capita ($US PPP*)

Total expenditures on healthas percent of GDP

61

EFFICIENCY



35/573

Duplicate Medical Tests, Among Sicker Adults

1820

4

8 9

10

15 16

0

10

20

30

NETH CAN UK NZ AUS GER




EFFICIENCY

2005 2007

United States

Percent reporting that doctor ordered test that had already been done in past two years


Test Results or Medical Records Not Available atTime of Appointment, Among Sicker Adults

2322

9

1214

17 17 18

0

10

20

30

NETH GER NZ AUS UK CAN




EFFICIENCY

Percent reporting test results/records not available at time of appointment in past two years

2005 2007

United States



36/573

Managed Care Health Plans: Potentially InappropriateImaging Studies for Low Back Pain, by Plan Type

26

22

19

15

35

29

0

10

20

30

40

Private Medicaid

Mean 10th %ile 90th %ile

Percent of health plan members (ages 1850) who received an imaging studywithin 28 days following an episode of acute low back pain with no risk factors

25 25 26

2221 22

2004* 2005 2006

Private Medicaid

Annual averagesManaged care plans (2006)

* Denotes baseline year.

Data: Healthcare Effectiveness Data and Information Set (NCQA 2007).

EFFICIENCY


Went to Emergency Room for Condition That Could Have Been Treatedby Regular Doctor, Among Sicker Adults

26

21

68 8

11

16

19

0

10

20

30

GER NETH NZ UK AUS CAN




EFFICIENCY

2005 2007

United States

Percent of adults who went to ER in past two years for condition that could have beentreated by regular doctor if available



37/573

Ambulatory CareSensitive (Potentially Preventable) HospitalAdmissions for Select Conditions

178

62

242

156

49

230

U.S.

Average

Top 10%

states

Bottom 10%

states

EFFICIENCY

241

137

299

240

126

293

U.S.

Average

Top 10%

states

Bottom 10%

states

2002/2003 2004

Adjusted rate per 100,000 population

498

258

631

476

246

634

0

100

200

300

400

500

600

700

U.S.

Average

Top 10%

states

Bottom

10% states

Diabetes*Heart failure Pediatric asthma

^ 2002 data for heart failure and diabetes; 2003 data for pediatric asthma. *Combines four diabetes admission measures:

uncontrolled, short-term complications, long-term complications, and lower extremity amputations.

Data: National averageHealthcare Cost and Utilization Project, Nationwide Inpatient Sample; State distributionState InpatientDatabases; not all states participate in HCUP (AHRQ 2005, 2007a).


Medicare Admissions for Ambulatory CareSensitive Conditions,Rates and Associated Costs, by Hospital Referral Regions

771

499

610

887

1043

700

465

558

816

926

0

300

600

900

1200

National

mean

10th 25th 75th 90th

2003 2005

13.4

10.0

11.8

14.7

16.3

12.6

9.8

11.1

13.6

15.2

0

5

10

15

20

National

mean

10th 25th 75th 90th

2003 2005

Rate of ACS admissions per 10,000beneficiaries

Costs of ACS admissions as percent of alldischarge costs

Percentiles Percentiles

See report Appendix B for complete list of ambulatory care-sensitive conditions used in the analysis.Data: G. Anderson and R. Herbert, Johns Hopkins University analysis of Medicare Standard Analytical Files (SAF) 5% Inpatient

Data.

EFFICIENCY



38/573

18

16

2021

15 16

19 20

14

18

0

10

20

30

2003 2005 10th 25th 75th 90th 10th 25th 75th 90th

Medicare Hospital 30-Day Readmission Rates

Hospital Referral Region State Percentiles, 2005

Percent of Medicare beneficiaries admitted for one of 31 select conditions

who are readmitted within 30 days following discharge*

* See report Appendix B for list of conditions used in the analysis.

Data: G. Anderson and R. Herbert, Johns Hopkins University analysis of Medicare Standard Analytical Files (SAF) 5%

Inpatient Data.

EFFICIENCY

U.S. Mean


0.80

0.90

1.00

1.10

1.20

$0 $5,000 $10,000 $15,000 $20,000 $25,000 $30,000 $35,000 $40,000

Relative Resource Use**

Quality and Costs of Care for Medicare Patients Hospitalizedfor Heart Attacks, Hip Fractures, or Colon Cancer,

by Hospital Referral Regions, 2004

EFFICIENCY

* Indexed to risk-adjusted 1-year survival rate (median=0.70).

** Risk-adjusted spending on hospital and physician services using standardized national prices.

Data: E. Fisher, J. Sutherland, and D. Radley, Dartmouth Medical School analysis of data from a 20% national sample

of Medicare beneficiaries.

Median relative resource use=$27,499

Qua

lityo

fCare

*

(1-Year

Surv

iva

lIndex,

Me

dian=

70%)


Percentiles, 2005


39/573

Quality and Costs of Care for Medicare Patients Hospitalizedfor Heart Attacks, Hip Fractures, or Colon Cancer,

by Hospital Referral Regions

30

27 28

30 31

3230

27 29

30 31

33

0

10

20

30

40

Mean of

highest

90%

10th 25th Median 75th 90th

2000-2002 2004

1-year mortality rate Annual relative resource use, 2004*

* Risk-adjusted spending on hospital and physician services using standardized national prices.

Data: E. Fisher, J. Sutherland, and D. Radley, Dartmouth Medical School analysis of data from a 20% national sample of

Medicare beneficiaries.

$28,011

$24,906$25,929

$27,499 $28,831

$30,263

Mean of

highest

90%

10th 25th Median 75th 90th

Deaths per 100 Dollars ($)

70

Percentiles Percentiles

EFFICIENCY


Costs of Care for Medicare Beneficiaries with Multiple ChronicConditions, by Hospital Referral Regions, 2001 and 2005

Heart Failure + COPD

1.48

1.36

2.03

1.77

$18,024

$20,062

$15,246

$17,180

$10,304

$12,665

$8,872

$11,317

$13,188

$15,367

2001

2005

1.43

1.40

2.14

1.99

$27,310

$32,199

$20,592

$26,035

$14,355

$18,649

$12,747

$16,144

$18,461$23,056

2001

2005

$20,960

$25,732

All 3 conditions

Ratio of percentilegroupsAverage annual reimbursement

2.13

1.89

2.102.06

90th to10th

$32,732

$37,450

$43,973

$53,019

90thpercentile

$22,415

$27,498

$31,792

$38,004

Average

$25,023

$31,709

$37,879

$44,216

75thpercentile

1.45

1.44

$17,312

$22,044

$15,355

$19,787

2001

2004

Diabetes + COPD

Diabetes + Heart Failure

1.58

1.48

$23,973

$29,936

2001

2005

75th to25th

25thpercentile

10thpercentile

COPD=chronic obstructive pulmonary disease.

Data: G. Anderson and R. Herbert, Johns Hopkins University analysis of Medicare Standard Analytical Files (SAF) 5%

Inpatient Data.

EFFICIENCY



40/573

Percentage of National Health Expenditures Spent onInsurance Administration, 2005

a 2004 b1999

* Includes claims administration, underwriting, marketing, profits, and other administrative costs;

based on premiums minus claims expenses for private insurance.

Data: OECD Health Data 2007, Version 10/2007.

Net costs of health insurance administration as percent of national health expenditures

EFFICIENCY

1.92.3

2.83.3

3.9 4.2 4.3

4.8

5.6

6.97.5

0

2

4

6

8

10

Finland

Japan

Australia

UnitedKingdom

Austria

Canada

Netherlands

Switzerland

Germany

France

UnitedStates*

a aab


Physicians Use of Electronic Medical Records

17

28

9892

89

79

42

23

0

25

50

75

100

NETH NZ UK AUS GER CAN



Data: 2001 and 2006 Commonwealth Fund International Health Policy Survey of Physicians.

EFFICIENCY

Percent of primary care physicians using electronic medical records

2001 2006

United States



41/573

SECTION 5: EQUITY

EQUITY

For equity, the Scorecard contrasts rates of risk by insurance, income, and

race/ethnicity. Specifically, the risk ratios compare: Insured to uninsured rates

High-income to low-income rates

White to black rates

White to Hispanic rates

Indicators used to score equity include a subset of main indicators and a few

equity-only indicators to highlight certain areas of concern. They are grouped

as follows:

Long, healthy & productive lives

Effective care

Safe care

Patient-centered, timely care

Coordinated and efficient care Universal participation and affordable care

Charts for equity indicators are interspersed throughout other sections as

appropriate.


Infant Mortality

5.7

9

6.6

4.1

13.6

15.2

13.6

11.9

5.5 5.4 5.34.7

Total Less than high

school

High school

graduate

At least some

college

White Black Hispanic

EQUITY: LONG, HEALTHY & PRODUCTIVE LIVES

Infant deaths per 1,000 live births

14.7

9.0

6.35.7

13.6

6.3

5.5

5.34.7

8.4

0

5

10

15

20

1995

1996

1997

1998

1999

2000

2001

2002

^20

0320

04


By Mothers Education and Race/Ethnicity, 2004By Race/Ethnicity, 19952004


^ Denotes baseline year. PI=Pacific Islander; AI/AN=American Indian or Alaskan Native.

Data: National Vital Statistics System, Linked Birth and Infant Death Data (AHRQ 2007b, Mathews 2007).


42/573

Working-Age Adults with Health Limits on Activities or Work, 2006

12.9

9.2 10.3

19.617.0

9.2

15.6

27.328.4

12.8

29.4

48.2

0

25

50

U.S.

Average

Age 1829 Age 3049 Age 5064

$50,000+ $25,000-49,000


43/573

Coronary Heart Disease and Diabetes-Related Mortality,by Race/Ethnicity and Education Level, 2004

160 159

207

127

101

73

30

0

50

100

150

200

250

Total White Black Hispanic Lessthan highschool

Highschool

graduate

At leastsome

college


Coronary Heart Disease Mortality

Age-adjusted per 100,000 population

7668

135

90

62

40

17

0

50

100

150

200

250

Total White Black Hispanic Less thanhigh

school

Highschool

graduate

At leastsome

college

Diabetes-Related Mortality

Note: Data by education level based on total of 36 reporting states and D.C. for people ages 2564.

Data: National Vital Statistics SystemMortality (Retrieved from DATA2010 at http://wonder.cdc.gov/data2010).

EQUITY: LONG, HEALTHY & PRODUCTIVE LIVES

4245

39

28 30

49

37

32

46

30

21

0

20

40

60

Total

White

Black

Hispan

icOth

er

400%+

ofpover

t

200%-

399%

ofpov

er


44/574

18

14

4240

10

44

Total

White

Black

Mexic

an

400%+

ofpovert


45/574

1712

23 26

15 15 14

2219

37

0

25

50

75

100

TotalWhite BlackHispanic High*Middle*

Nearpoor

*Poor*InsuredUn

insured

Adults with Poorly Controlled Chronic Diseases, by Race/Ethnicity,Family Income, and Insurance Status, 19992004

Percent of adults (ages 18+) with diagnoseddiabetes with HbA1c level 9%

Percent of adults (ages 18+) with hypertensionwith blood pressure 140/90 mmHg

* High refers to household incomes >400% of federal poverty level (FPL); middle to 200%399% FPL; near poor to

100%199% FPL; and poor to


46/574

Medical, Medication, and Lab Errors, by Race/Ethnicity,Income, and Insurance Status, 2007

20 2022

1618

24

18

25

0

20

40

Total White Black Hispanic Above

average

Below

average

Insured all

year

Uninsured

any time

Race/ethnicity Income Insurance status



EQUITY: SAFE CARE

Percent of adults ages 1864 reporting medical mistake, medication error, or lab error inpast two years

Select AHRQ Patient Safety Indicators, 2004

9.27.91.317.6135.6Uninsured/self pay

PATIENT RESIDENCE

10.910.01.729.8121.5Urban

111.3

112.2

119.4

124.0

140.3

130.4

116.8

122.3

Failure to rescue

7.6

7.8

9.2

10.2

6.4

8.2

10.7

8.4

Postoperativepulmonary embolus ordeep vein thrombosis

INSURANCE

9.81.626.5$45,000 or more

8.71.219.0Private insurance

10.31.221.7Rural

14.91.629.6Less than $25,000

MEDIAN INCOME OFPATIENT ZIPCODE

12.41.422.4Asian/Pacific Islander

11.31.227.2Hispanic

10.91.936.0Black

10.41.724.3White

RACE/ETHNICITY

Postoperativesepsis

Selected infectionsdue to medical care

Decubitusulcers

Risk adjusted rate per

1,000 discharges*

* Rates exclude complications present on admission and are adjusted for gender, comorbidities, and diagnosis-related group

clusters.

Data: Race/ethnicityHCUP, State Inpatient Database (AHRQ 2007b); income area, insurance, and patient residence

Healthcare Cost and Utilization Project, Nationwide Inpatient Sample (AHRQ 2007a).


EQUITY: SAFE CARE


47/574

Pressure Sores Among High-Risk and Short-Stay Residentsin Nursing Facilities by Race/Ethnicity, 2005

13

20

17

25

14

24

11

22

13

21

0

20

40

High risk residents Short stay residents



EQUITY: SAFE CARE

Percent of nursing home residents with pressure sores

PI=Pacific Islander; AI/AN=American Indian or Alaskan Native.

Data: Nursing Home Minimum Data Set (AHRQ 2007b).

Waiting Time to See Doctor When Sick, by Race/Ethnicity,Income, and Insurance Status, 2007

20

16

36

28

16

26

18

27

0

20

40


average

Below

average

Insured all

year

Uninsured

any time



Percent of adults ages 1864 who reported waiting six or more days for anappointment when sick or needed medical attention


EQUITY: PATIENT-CENTERED, TIMELY CARE


48/574

DoctorPatient Communication by Race/Ethnicity, Family Income,Insurance, and Residence, 2004

Percent of adults (ages 18+) reporting health providers sometimes or never listen carefully,explain things clearly, respect what they say, and spend enough time with them

* Insurance for people ages 1864. ** Urban refers to metropolitan area >1 million inhabitants; Rural refersto noncore area


49/574

Test Results or Medical Record Not Available at Time of Appointment,by Race/Ethnicity, Income, and Insurance Status, 2007

1715

20 20

12

23

14

23

0

10

20

30


average

Below

average

Insured all

year

Uninsured

any time




EQUITY: COORDINATED AND EFFICIENT CARE

Percent reporting test results/records not available at time of appointment in past two years

Went to Emergency Room for Condition That Could Have Been Treatedby Regular Doctor, by Race/Ethnicity, Income, andInsurance Status, 2007

15 15

22

11 11

22

13

20

0

10

20

30


average

Below

average

Insured all

year

Uninsured

any time




EQUITY: COORDINATED AND EFFICIENT CARE

Percent of adults who went to ER in past two years for condition that could have beentreated by regular doctor if available


50/57


51/574

Cost-Related Access Problems, by Race/Ethnicity, Income,and Insurance Status, 2007

72

35

50

26

45

46

45

61

46

0 20 40 60 80 100

Uninsured during year

Insured all year


52/574

Primary Care Medical Residency Positions Filled by U.S. MedicalSchool Graduating Seniors and Other Applicants: 1997-2007

3,167

1,9671,648 1,602

837

1,1551,384 1,406

0

1,000

2,000

3,000

4,000

5,000

1997 2002 2006 2007

Positions filled by other applicants*

Positions filled by U.S. medical school graduating seniors

Note: Includes family medicine, family medicine-psychiatry, internal medicine-primary, internal medicine-family medicine, internal

medicine-pediatrics, and pediatrics-primary positions. *Other applicants includes U.S. physicians, osteopaths, 5th Pathway,

Canadian students, and U.S. and non-U.S. graduates of international medical schools.

Data: American Academy of Family Physicians analysis of National Resident Matching Program Advanced Data Tables, 2007.

4,004

3,122 3,032 3,008

SYSTEM CAPACITY


Data: 2006 Press Ganey Associates, Inc. Data represent the experiences of 121,882 employees across 132 facilities in 2006.

Hospital Employee Satisfaction, 2006

58.3 61.2

65.8 68.0 71.4

60.3 63.1

66.2 68.8

71.5

0

25

50

75

100

10th percentile 25th percentile 50th percentile 75th percentile 90th percentile

Registered Nurses All Employees

97

SYSTEM CAPACITY


Overall Satisfaction Score


53/574

Nursing Home Workforce Satisfaction, 2006

3844

5158

64

37

44

52

59

66

4449

5560

65

0

25

50

75

100

10th percentile 25th percentile 50th percentile 75th percentile 90th percentile

Nursing assistants* Nurses All nursing home employees

Composite satisfaction scores (average of 21 survey items) where 100=excellent and 0=poor

Data: MyInnerView, Inc., 2006 National Survey of Nursing Home Workforce Satisfaction. Scores are national estimates from

106,858 staff in 1,933 nursing facilities in every state (except Alaska) and the District of Columbia. *CNA/NA


SYSTEM CAPACITY

Hospital Nursing Staff Vacancy Rates, 2000

10

15 14

12

10

1211

9 9

0

5

10

15

20

National

average

Critical

care

Medical/

Surgical

ER Obstetrics West South Northeast Midwest

Percent

Data: American Organization of Nurse Executives 2000 Acute Care Hospital Survey of RN Vacancies and Turnover Rates.

Type of acute care Region

99

SYSTEM CAPACITY



54/57


55/575

Hospital Organizational Culture: Staff Perceptionsof Teamwork and Learning Environment, 2007

79

70

57

44

96 9491

8287

80

72

56

71

61

44

32

0

25

50

75

100

Teamwork withinunits

Organizationallearning & continuous

improvement

Teamwork acrossunits

Nonpunitive responseto error

Average Best hospital 90th %tile hospitals 10th %tile hospitals

Percent of staff giving positive responses

Data: Hospital Survey on Patient Safety Culture Comparative Database, results for 160,176 staff in 519 participating hospitals

submitting data in 2007. Agency for Healthcare Research and Quality.

SYSTEM CAPACITY


Adoption of Culture Change by Nursing Homes, 2007

Categories of Nursing Homes, by Extent of Culture Change Adoption

SYSTEM CAPACITY

CULTURE CHANGEADOPTERS

31%

CULTURE CHANGESTRIVERS

25%

TRADITIONAL43%

Culture change definition*

describes nursing home only in a

few respects or not at all, and

leadership is not very committedto adopting culture change

Culture change definition*completely or for the most part

describes nursing home

Culture change definition* describes

nursing home only in a few respects

or not at all, but leadership is

extremely or very committed to

adopting culture change

* Culture change or a resident-centered approach means an organization that has home and work environments in which: care and

all resident-related activities are decided by the resident; living environment is designed to be a home rather than institution; close

relationships exist between residents, family members, staff, and community; work is organized to support and allow all staff torespond to residents' needs and desires; management allows collaborative and group decision making; and processes/measures

are used for continuous quality improvement.

Data: 2007 Commonwealth Fund National Survey of Nursing Homes.



56/575

National Health Expenditures Spent on Public Health ActivitiesCompared with Insurance Administration Costs

55

35

78

0

20

40

60

80

100

National health

expenditures

Government public

health activities

Insurance

administrative

costs

43.4

81.8

53.9

129.0

58.7

145.4

0

25

50

75

100

125

150

175

Government public health

activities

Insurance administrative

costs

2000 2004 2006

Data: CMS Office of the Actuary, National Health Statistics Group; and U.S. Dept. of Commerce,

Bureau of Economic Analysis and U.S. Bureau of the Census (Catlin et al. 2008).

Dollars (in billions) Percent growth from 2000 to 2006

104

SYSTEM CAPACITY


References

AHCA (American Health Care Association). 2003. Results of the 2002 AHCA survey of nursing staff vacancy and

turnover in Nursing Homes. Washington, D.C.: American Health Care Association.

AHRQ (Agency for Healthcare Research and Quality).

2007a. National Healthcare Quality Report, 2007: Data Tables Appendix. http://www.ahrq.gov/qual/nhqr07/

2007b. National Healthcare Disparities Report, 2007: Appendix D: Data Tables. http://www.ahrq.gov/qual/nhdr07/

2006. National Healthcare Quality Report, 2006. Data Tables Appendix. http://www.ahrq.gov/qual/nhqr06/



2003. National Healthcare Quality Report, 2003.

Allred, N., K. Wooten, and Y. Kong, The association of health insurance and continuous primary care in the medical

home on vaccination coverage for 19- to 35-month-old children, Pediatrics 119, no 1 (2007):4-11.

Catlin, A., et al., National health spending in 2006: a year of change for prescription drugs, Health Affairs 27, no 1

(2008):14-29.

Clegg, L., et al., Cancer survival among US whites and minorities: a SEER program population-based study,Archivesof Internal Medicine 162, no 17 (2002):1985-93.

Edwards, J., et al., National Healthcare Safety Network, data summary for 2006, issued June 2007,American Journal

of Infection Control35 (2007):290-301.

HRSA (Health Resources and Services Administration). 2005. The National Survey of Childrens Health 2003. Rockville,

M.D.: U.S. Department of Health and Human Services.Mathews, T., and M. MacDorman, Infant mortality statistics from the 2004 period linked birth/infant death data set,

National Vital Statistics Report55, no 15 (2007). Hyattsville, Md.: National Center for Health Statistics.

MedPAC (Medicare Payment Advisory Commission). 2007. Quality of care in the Medicare program.A Data Book:Healthcare Spending and the Medicare Program. Washington, D.C.: Medicare Payment Advisory Committee.

MedPAC (Medicare Payment Advisory Commission). 2005. Quality of care for Medicare beneficiaries.A Data Book:

Healthcare Spending and the Medicare Program. Washington, D.C.: Medicare Payment Advisory Committee.

Nolte, E., and C. M. McKee, Measuring the health of nations: updating an earlier analysis, Health Affairs 27, no 1

(2008):58-71.



57/57

References (continued)

NCHS (National Center for Health Statistics). 2007. Health, United States, 2007. Hyattsville, Md.: Centers for Disease

Control and Prevention.

NCQA (National Committee for Quality Assurance). 2007. HEDIS Audit Means, Percentiles and Ratios: 2006.Washington, D.C.: National Committee for Quality Assurance.

Pace, K., et al. 2005. Acute hospitalization of home health patients report of analyses, literature review and technical

expert panel. Paper presented at the 2005 National Association for Home Care Annual Meeting, Seattle,

Washington and 2005 Tri-Regional QIO Conference, St. Pete Beach, Fla.

SAMHSA (Substance Abuse and Mental Health Services Administration). 2007. Results from the 2006 National Survey

on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-32, DHHS Publication No.

SMA 07-4293). Rockville, Md.

SAMHSA (Substance Abuse and Mental Health Services Administration). 2006. Results from the 2005 National Survey

on Drug Use and Health: National Findings (Office of Applied Studies, NSDUH Series H-30, DHHS Publication No.

SMA 06-4194). Rockville, Md.

Singh G., et al. 2003.Area socioeconomic variations in US cancer incidence, mortality, stage, treatment, and survival

1975-1999. NCI Cancer Surveillance Monograph Series, Number 4. NIH Publication No. 03-5417. Bethesda, Md.:National Cancer Institute.

WHO (World Health Organization). 2003. The World Health Report 2003: shaping the future. Geneva, Switzerland:

World Health Organization.


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