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The Commonwealth Fund's scorecard report, Why Not the Best? Results from a National Scorecard on U.S. Health System Performance, used a variety of ´óÏóAPPproducts, research, and tools. The scorecard is a comprehensive means of measuring and monitoring health care outcomes, quality, access, efficiency, and equity in one report.

Released in September 2006, the scorecard assesses how well the U.S. health system is performing as a whole relative to what is achievable. It uses national and international data to identify performance benchmarks and calculate simple ratio scores comparing U.S. averages to the benchmarks.

In developing the scorecard, ´óÏóAPPPrevention Quality Indicators and Hospital Consumer Assessment of Health Providers and Systems (H-CAHPS) data were used, in addition to MEPS data. The report also cites data from the 2005 National Healthcare Disparities Report (NHDR) and the National Healthcare Quality Report (NHQR).

´óÏóAPPPrevention Quality Indicators, HCUP-Nationwide Inpatient Sample, and State Inpatient Databases were used in determining scores for equity and efficiency as related to hospital admissions for ambulatory care-sensitive conditions. MEPS data were used to create the composite adult preventive care, primary care source, and affordability indicators.

The CAHPS® benchmarking database was used for the H-CAHPS composites. The NHQR and the NHDR were cited throughout various sections relating to quality and equity. The reports complement private sector score card efforts like the Commonwealth Fund by providing U.S.-based data over time, across states, and across priority populations on a set of over 200 measures. The Commonwealth Fund's report focuses on some of the same measures and provides international comparisons.

The Commonwealth Fund's Commission on a High Performance System identified priority areas—health outcomes, quality, access, equity, and efficiency—that build on the Institute of Medicine's work on quality, insurance, and equity. Thirty-seven indicators reflecting key concepts in these priority areas were selected based on an extensive review of journal articles or studies, in addition to a range of indicators developed by AHRQ, NCQA, CMS, the National Quality Forum, and other governmental and professional organizations.

Overall, the scorecard shows the U.S. health care system scored an average 66 out of a maximum 100, based on the 37 indicators. There were wide variations in performance across the country. The findings underscore the importance of policies that take a coherent whole-system approach to change and address the interaction of access, quality, and cost. The scorecard will continue to monitor performance over time.

For links to the full report, technical report, and chartpacks, go to: .