We've mentioned soaring U.S. health costs many times before, but a recent Commonwealth Fund report puts into perspective '"what we pay for" versus "what we get" from our health system.  In comparison to other industrialized nations, according to The Washington Post, the U.S. is one of the top spenders on health care -- $2.4 trillion annually -- but we rank near the bottom in preventable deaths.

The report, Reducing Preventable Deaths Through Improved Health System Performance, found the US had the highest rate of preventable deaths, with 110 out of 100,000 dying in 2002-2003. For example, controlling for age and whether death is preventable from certain conditions, the study found women under the age 75 died from health care-amenable causes at a rate of 96.41 per 100,000 in the U.S., versus 68.15 in Canada and 57.40 in France. Though all countries made progress in lowering rates of preventable deaths between 1997 to 1998 and 2002 to 2003, the United States made the least progress, dropping from 15th overall in preventable mortality to 19th, said a similar study in Health Affairs.

The U.S. ranks very low on premature deaths caused by illnesses such as diabetes, stroke, ulcers, and pneumonia. Complicated cancers, AIDS, and most forms of heart disease were not considered preventable in the definitions used here (ie once someone gets these conditions, medical treatment can't always stop a premature death). Gun and automobile accident fatalities were not a big contributor to the preventable death rate either.

"Chronic illnesses are a much bigger driver of health-care costs than trauma cases such as vehicle crashes and gunshots," Robert Shesser, head of emergency medicine at George Washington University, told the Post. "Because of our wacky system, some people are bankrupted or avoiding care and some are getting too much care."

The Commonwealth Fund suggests several health reform strategies as a path to lowering preventable mortality in the United States, including extending affordable insurance to all Americans and realigning financial incentives to enhance value and achieve savings. The report said,

We also must reform our payment system, as fee-for-service incentives reward more services and not necessarily better care. Good preventive care, for example, requires not just a screening test, but also services that are not currently reimbursed such as outreach and follow-up when a test is positive.

Outreach and follow-up care are facilitated when patients have a medical home that serves as a regular source of care and coordinates care for people. Medical homes that are paid per patient can encourage preventive care by sending electronic reminders of screening visits-reminding patients that it's time for their cholesterol check, for example.

In health care, "prevention" can mean different things, from encouraging overall healthy lifestyles to avoiding certain diseases, to using medical checkups and screenings to catch disease early. As the Post points out,

...as many as 80 million Americans are uninsured or underinsured, which means they have little access to a regular physician, checkups, preventive services, affordable prescription drugs, dental care or screening tests.

Without health reform that provides everyone with quality, sustainable, affordable health care coverage, many Americans will continue to struggle to stay healthy, and access the preventative health services that could end up saving their lives.