Access to U.S. health care is declining despite the fact that costs are higher than ever, data from the latest national health care scorecard indicate.

The U.S. scored 64 out of 100 on key measures of healthcare performance, down from 67 the first year it was assessed in 1996.

The Commonwealth Fund Commission on a High Performance Health System calculates scores using 42 key healthcare indicators encompassing quality, access, efficiency, equity and healthy lives. Average U.S. performance in these areas is then compared to the top 10% of states, regions, health plans, hospitals and other providers, as well as top performing countries.

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“The US still spends up to twice as much on health care as other high-income countries, but too often fails to deliver what people need – timely access to high quality, efficient health care,” Maureen Bisognano, president of the Institute for Healthcare Improvement in Boston and Commonwealth Fund member, said in a press release.

The U.S. came in last in terms of deaths that could have been prevented with timely and effective medical care among all 16 developed countries included in the ranking.

Furthermore, overall infant mortality is 35% higher nationwide than in top performing states, and other high-income countries reported infant mortality even lower than the best rates observed in U.S. states.

If the United States performed as well as France, the top ranked country in this category, it would result in 91,000 fewer premature infant deaths each year, according to the report.

Health care appears to have declined most rapidly in the areas of access and affordability, with the number of uninsured or under-insured adults increasing from 61 million in 2003 to 81 million in 2010.

For those with health insurance premiums rose faster than incomes — in 2009 only 4% of the U.S. population lived in a state in which insurance premiums averaged less than 15% of the median income, compared with 57% in 2003.

These high costs are taking a toll on personal finances, the report indicated. Among working adults, 40% had medical debt in 2010, up from 34% in 2005.

In the efficiency category, the U.S. scored 53 out of 100 based on duplicative services, high hospital readmission rates, low use of electronic health information systems and high administrative costs. In both 2003 and 2009, 20% of Medicare patients who were hospitalized for a certain condition or procedure were readmitted within 30 days.

Other findings indicate that in 2008, one-in-four elderly Medicare beneficiaries were prescribed a potentially inappropriate drug; one-third of children aged 10 to 17 were overweight or obese; only half of adults reported receiving all recommended preventive care and 44% reported that they did not have a primary care provider.

Despite these findings, the report did note improvements in several areas. Half of adults with hypertension reported having their BP under control in 2007-2008 compared with 31% in 1999-2000, and the percentage of adults who reported smoking fell from 21% in 2004 to 17% in 2010.

Overall there was more public reporting of quality data than in previous years; more hospitals adhered to recommended protocols to prevent surgical complications; and overall hospital admissions for heart failure and pediatric asthma declined.

The researchers noted that most of the data included in the report were collected between 2007 and 2009, before the Affordable Care Act was passed.

“This year’s scorecard makes it clear that changes in the Affordable Care Act designed to reduce waste, cut costs and help people afford the care they need are on targeted, “ Commonwealth Fund president, Karen Davis, said in a press release. “The health and future economic security of the country depend on moving forward these crucial reforms.”

Schoen C et al. Why not the best? Results from the National Scorecard on U.S. Health System Performances, 2011. Oct. 18, 2011.