Figure 1. Mortality Amenable to Health Care
Mortality from causes considered amenable to health care is deaths before age 75
that are potentially preventable with timely and appropriate medical care
Deaths per 100,000 population*
International
variation, 1998
150
100
75
92
88 88 88
84
81
97 97 99
106 107 109 109
State variation, 134
2002
129 130 132
115 115
119
110
103
84
90
50
Fr
an
ce
Ja
pa
n
Sp
a
Sw in
ed
en
I
Au ta ly
st
ra
Ca l ia
na
N da
Ne or
th wa
y
er
la
nd
s
G
re
G ece
er
m
an
y
Ne Au
s
w
t
Ze ria
al
De an d
Un
n
ite m a
rk
d
St
at
es
Fi
nl
an
Un
ite Ire d
l
d
Ki and
ng
d
Po o m
rtu
ga
l
0
U.S.
avg
10th 25th Med- 75th
ian
Percentiles
* Countries’ age-standardized death rates, ages 0–74; includes ischemic heart disease.
See Technical Appendix for list of conditions considered amenable to health care in the analysis.
Data: International estimates—World Health Organization, WHO mortality database (Nolte and McKee 2003);
State estimates—K. Hempstead, Rutgers University using Nolte and McKee methodology.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006.
90th
Figure 2. Infant Mortality Rate, 2002
Infant deaths per 1,000 live births
International variation
State variation
10
9.1
8.1
7.0
7.1
7.0
6.0
5.4 5.6
5.2
5.1
5.0 5.0 5.0 5.0
5
5.3
4.4 4.4 4.5 4.5
4.1 4.1 4.1 4.2 4.2
3.0 3.0
3.3 3.5
2.2
Ic
el
a
nd
Ja
pa
Fi n
nl
an
Sw d
ed
e
No n
rw
ay
Sp
ai
Fr n
an
ce
Cz
A
ec
us
h
Re tria
pu
b
Ge lic
rm
a
Be ny
lg
i
De um
nm
ar
k
Sw
Ita
ly
itz
Ne erla
nd
th
er
la
n
Au ds
st
ra
Po lia
rtu
ga
Ire l
la
nd
Un
G
ite
re
d
ec
Ki
ng e
do
m
C
an
Ne
a
w
da
Z
Un eal
ite and
d
St *
at
es
0
U.S.
avg
* 2001.
Data: International estimates—OECD Health Data 2005;
State estimates—National Vital Statistics System, Linked Birth and Infant Death Data (AHRQ 2005a).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006.
10th
25th
Median
75th
Percentiles
90th
Figure 3. Uninsured Rates High Among Adults
with Low and Moderate Incomes, 2001–2005
Percent of adults ages 19–64
75
Insured now, time uninsured in past year
Uninsured now
49
50
16
25
28
24 26
9
9 9
52 53
15 16
28
33 37 37
15 17 18
0
35
11
41
13
11
17
24 28
13
7
6
16 18
9 9
7 9
4
3
4
2
7
3
2001 2003 2005
2001 2003 2005
2001 2003 2005
2001 2003 2005
2001 2003 2005
Total
Low income
Moderate
income
Middle
income
High income
Note: Income refers to annual income. In 2001 and 2003, low income is <$20,000, moderate income is $20,000–
$34,999, middle income is $35,000–$59,999, and high income is $60,000 or more. In 2005, low income is <$20,000,
moderate income is $20,000–$39,999, middle income is $40,000–$59,999, and high income is $60,000 or more.
Source: S.R. Collins et al., Gaps in Health Insurance Coverage: An All-American Problem, Findings from the
Commonwealth Fund Biennial Health Insurance Survey, The Commonwealth Fund, April 2006.
Figure 4. Adults Ages 19–64 Who Are Uninsured
and Underinsured, by Poverty Status, 2003
Insured, not underinsured
Underinsured*
Uninsured during year
100%
26
80%
13
4
49
9
60%
83
40%
19
65
20%
32
0%
Total
200% of poverty or more
Under 200% of poverty
* Underinsured defined as insured all year but experienced one of the following: medical expenses equaled 10% or more of income;
medical expenses equaled 5% or more of incomes if low-income (<200% of poverty); or deductibles equaled 5% or more of income.
Data: 2003 Commonwealth Fund Biennial Health Insurance Survey (Schoen et al. 2005b).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006.
Figure 5. Access Problems Because of Costs in Five Countries,
Total and by Income, 2004
Percent of adults who had any of three access problems* in past year because of costs
80
Below average income
Above average income
57
44
40
40
35
34
29
29
26
24
25
17
12
9
12
6
0
UK
CAN
AUS
NZ
US
UK
CAN
* Did not get medical care because of cost of doctor’s visit, skipped medical test, treatment,
or follow-up because of cost, or did not fill Rx or skipped doses because of cost.
UK=United Kingdom; CAN=Canada; AUS=Australia; NZ=New Zealand; US=United States.
Data: 2004 Commonwealth Fund International Health Policy Survey of Adults’ Experiences
with Primary Care (Schoen et al. 2004; Huynh et al. 2006).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006.
AUS
NZ
US
Figure 6. Receipt of All Three Recommended Services
for Diabetics, by Race/Ethnicity, Family Income, Insurance,
and Residence, 2002
Percent of diabetics (ages 18+) who received HbA1c test, retinal exam, and foot exam in past year
Total
53
55
White
54
Black
38
Hispanic
61
400% + of poverty
200% –399% of poverty
50
100% –199% of poverty
47
46
<100% of poverty
Private*
54
24
Uninsured
Urban**
55
45
Rural
0
50
* Insurance for people ages 18–64.
** Urban refers to metropolitan area >1 million inhabitants; Rural refers to noncore area <10,000 inhabitants.
Data: 2002 Medical Expenditure Panel Survey (AHRQ 2005a).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006.
100
Figure 7. Adults Without Insurance Are Less Likely
to Be Able to Manage Chronic Conditions
Percent of adults ages 19–64 with at least one chronic condition*
Insured all year
Insured now, time uninsured in past year
Uninsured now
75
58
59
50
27
25
18
35
16
0
Skipped doses or did not fill
Visited ER, hospital, or both for chronic
prescription for chronic condition
condition
because of cost
*Hypertension, high blood pressure, or stroke; heart attack or heart disease; diabetes; asthma, emphysema, or lung disease.
Source: S. R. Collins, K. Davis, M. M. Doty, J. L. Kriss, A. L. Holmgren, Gaps in Health Insurance: An All-American Problem,
Findings from the Commonwealth Fund Biennial Health Insurance Survey (New York: The Commonwealth Fund, Apr. 2006).
Figure 8. Receipt of Recommended Screening and Preventive
Care for Adults, by Family Income and Insurance Status, 2002
Percent of adults (ages 18+) who received all recommended screening and
preventive care within a specific time frame given their age and sex*
National
49
400%+ of poverty
56
200%–399% of poverty
48
<200% of poverty
39
Insured all year
52
Uninsured part year
46
Uninsured all year
31
0
50
* Recommended care includes seven key screening and preventive services: blood pressure,
cholesterol, Pap, mammogram, fecal occult blood test or sigmoidoscopy/colonoscopy, and flu shot.
Data: B. Mahato, Columbia University analysis of 2002 Medical Expenditure Panel Survey.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006.
100
Figure 9. Preventive Care Visits for Children, by Top and Bottom
States, Race/Ethnicity, Family Income, and Insurance, 2003
Percent of children (ages <18) received BOTH a medical
and dental preventive care visit in past year
59
U.S. average
73
Top 10% states
48
Bottom 10% states
62
White
58
Black
49
Hispanic
70
400% + of poverty
48
<100% of poverty
63
Private insurance
35
Uninsured
0
50
Data: 2003 National Survey of Children’s Health (HRSA 2005; retrieved from Data Resource
Center for Child and Adolescent Health database at http://www.nschdata.org).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006.
100
Figure 10. Children with a Medical Home, by Top and Bottom
States, Race/Ethnicity, Family Income, and Insurance, 2003
Percent of children who have a personal doctor or nurse and receive care that is accessible,
comprehensive, culturally sensitive, and coordinated*
46
U.S. average
60
Top 10% states
36
Bottom 10% states
53
White
39
Black
30
Hispanic
58
400% + of poverty
31
<100% of poverty
53
Private insurance
23
Uninsured
0
50
100
* Child had 1+ preventive visit in past year; access to specialty care; personal doctor/nurse who usually/always spent enough
time and communicated clearly, provided telephone advice or urgent care and followed up after the child’s specialty care visits.
Data: 2003 National Survey of Children’s Health (HRSA 2005; retrieved from Data Resource Center for Child and Adolescent
Health database at http://www.nschdata.org).
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006.
Figure 11. Test Results or Medical Record Not Available
at Time of Appointment, Among Sicker Adults, 2005
Percent reporting test results/records not available at time of appointment in past two years
International comparison
United States, by race/ethnicity,
income, and insurance status
40
30
30
28
27
23
19
20
11
12
GER
AUS
16
16
NZ
UK
21
20
18
0
CAN
US
White
Black
Hispanic
Above
average
income
Below
average
income
Insured
GER=Germany; AUS=Australia; NZ=New Zealand; UK=United Kingdom; CAN=Canada; US=United States.
Data: Analysis of 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults; Schoen et al. 2005a.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006.
Uninsured
Figure 12. Duplicate Medical Tests,
Among Sicker Adults, 2005
Percent reporting that doctor ordered test that had already been done in past two years
United States, by race/ethnicity,
income, and insurance status
International comparison
40
25
23
23
21
20
20
18
16
15
11
9
10
NZ
CAN
AUS
12
6
0
UK
US
GER
White
Black
Hispanic
Above
average
income
Below
average
income
Insured
UK=United Kingdom; NZ=New Zealand; CAN=Canada; AUS=Australia; US=United States; GER=Germany.
Data: Analysis of 2005 Commonwealth Fund International Health Policy Survey of Sicker Adults; Schoen et al. 2005a.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006.
Uninsured
Figure 13. Health Expenditure Growth 2000–2005
for Selected Categories of Expenditures
Average annual percent growth in health expenditures, 2000–2005
20
15
10.7
10
8.6
8.0
7.9
12.0
6.1
5
0
Total
Hospital care
Physician & Nursing home &
clinical services home health
Source: A. Catlin et al., “National Health Spending in 2005: The Slowdown Continues,”
Health Affairs, Jan./Feb. 2007 26(1):142–53.
Prescription
drugs
Prog. admin. &
net cost of
private health
insurance
Figure 14. Percentage of National Health Expenditures
Spent on Health Administration and Insurance, 2003
Net costs of health administration and health insurance
as percent of national health expenditures
8
7.3
5.6
6
4.8
4.0
4
4.1
4.2
3.3
2.6
2.1
1.9
2.1
2
0
a
ce
n
a
Fr
a2002
b1999
d
an
l
n
Fi
an
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Ja
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da
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e
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a
tri
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Au
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a
a
r
l
st
er
u
z
t
i
A
Sw
c2001
*Includes claims administration, underwriting, marketing, profits, and other administrative costs;
based on premiums minus claims expenses for private insurance.
Data: OECD Health Data 2005.
Source: Commonwealth Fund National Scorecard on U.S. Health System Performance, 2006.
*
y
s
n
e
t
a
ta
m
r
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e
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Figure 15.
Figure 16.
Figure 17.
Figure 18.
Figure 19.
Figure 20.
Figure 21.
Figure 22.