MINNEAPOLIS, July 21, 2008—The annual score card from the Commonwealth Fund shows that care in the U.S. typically falls far short of what is achievable. Quality of care is highly variable, and opportunities are routinely missed to prevent disease, disability, hospitalization, and mortality.

Across 37 indicators of performance, the U.S. achieves an overall score of 65 out of a possible 100 -- a C minus grade -- compared with international performance benchmarks. 

Overall, performance has not improved from 2006 to 2008. Access to health care significantly declined, while health system efficiency remained low.

Quality metrics that have been the focus of national campaigns or public reporting efforts did show gains. 

The report shows a huge jump in the number of people without health coverage, and in the number of people who are exposed to financial ruin because of high health costs and inadequate insurance.

Forty-one percent of U.S. adults have "problems" with medical bills or outstanding medical debt, up from 34 percent two years before. At the same time, around 60 percent of those people experience financial problems with medical costs despite having health coverage, according to the report.

The report shows only about half of U.S. adults received recommended preventive care (such as vaccines, blood pressure checks, and cancer screenings) in 2005, the latest year from which data are available.

It also shows getting care after hours or on weekends without going to an emergency room is a much harder prospect for Americans than for people in other countries.

Download the full Commonwealth Fund report