Commonwealth's 7 Steps

Considering that the United States spends far more money per capita than any other country in the world on healthcare, it’s fair to take those extra resources into account when grading. If we spent what Morocco spends, for instance, our patient outcomes would garner an ‘A’ grade.
We might even get a ‘B’ for coverage — after all, Medicare keeps a lot of Americans healthy.
In regard to cost containment, the idea falls apart. We have no cost-containment; our system is completely unsustainable.
Even with all that being the case, we could do better, even without the reform that is so obviously needed.
Commonwealth Fund President Karen Davis has written up seven suggestions, with examples, for “Achieving the Best Health System in the World.”
Or at least scrabbling up from a failing grade.
She urges that we:

1. Extend Health Insurance to All

Example: State of Maine

This isn’t her best example. Dirigo Health has stumbled getting people enrolled. The goal was to cover all of the roughly 130,000 uninsured Maine residents by 2009, but so far fewer than 20,000 have signed up, according to the New York Times. Enrollment had to be capped because of a shortage of money.
Davis writes that “increased federal financing are likely to be needed to extend these approaches to states with higher rates of uninsured and more limited ability to fund coverage from local sources.”
In fact, we may need to consider selling California off to fund our insatiable system. That should pay for it for possibly a decade. Maybe more.
Wouldn't Belgium, Canada, France, Great Britain, Germany, Japan, Spain — geez, any of the other industrialized countries in the world — have been a better example?

2. Pursue Excellence in Provision of Safe, Effective, and Efficient Care

Example: University of Colorado Health Sciences Center
Here Davis is pushing the “use of evidence-based medicine, promoting effective chronic care management techniques, prioritizing patient safety, and ensuring care coordination across sites of care, especially when transitioning from the hospital to other settings.”
All these things seem self-evident; but true to form, libertarian think tanker Linda Gorman and insurance man Allan Jensen spoke out against them at a recent Colorado Health Care Reform (208) Commission meeting. According to them, evidence-based medicine is actually very problematic. Of course. Same as evolution. Just a theory.

3. Organize the Care System to Ensure Coordinated and Accessible Care for All

Example: Mount Sinai School of Medicine EXPORT Center
Providers should address system failures and target improving healthcare delivery to underserved populations.
Hard to accomplish with an inchoate, fragmented non-system, but a good goal.

4. Develop the Workforce to Foster Patient-Centered and Primary Care

Example: Denmark
“The U.S. is strikingly different from other industrialized countries in one important respect: its relative under-investment in patient-centered primary care. The U.S. has a much lower fraction of primary care physicians, and much better financial rewards for specialty care. A review of the literature indicates that better access to primary care lowers total cost and improves outcomes.
“In Denmark, which has the highest public satisfaction with health care of any country in Europe, primary care is much more accessible than in the U.S. A blend of capitation and fee-for-service payments to generalist physicians in Denmark assures that everyone has a primary care physician or "medical home," and generalist physicians typically provide services quickly, often in same-day appointments.”
I don’t know what Denmark’s percentage of GPs is, but in France, in 2002, 53.3 percent of physicians were in general/family practice. Compare that to 22.5 percent of U.S. doctors in general or family practice.

5. Increase Transparency and Reward Quality and Efficiency

Examples: Massachusetts Health Quality Partners Increase Transparency and New York State
“Public reporting of information on the performance of health plans and providers can spur improvements in quality and efficiency, by helping consumers make more informed decisions and by stimulating providers and plans to be more accountable for their results.”

6. Expand the Use of Information Technology and Exchange

Example: Rhode Island Information Exchange
“The Rhode Island Health Information Exchange (HIE) initiative is a public–private effort to allow providers, with their patients' permission, to electronically access important patient health information from a variety of sources.”

7. Encourage Leadership and Collaboration among Public and Private Stakeholders

Example: Puget Sound Health Alliance
The alliance “is an independent non-profit organization composed of employers, physicians, hospitals, consumers, health plans and other interested parties. The group's aim is to improve care and continuity by developing guidelines for providers, self-management and decision-making tools for patients and consumers, evaluations and reports on quality, and a collaborative approach to quality improvement.”

These are improvements that need to take place in most countries. It’s notable that European countries are far ahead of the U.S. in all of these points.