Despite spending twice per capita what other major industrialized countries spend on healthcare, and with some pockets of improvement, the U.S. healthcare system is still on average less efficient, less effective, and less accessible than ever, according to a report by the Commonwealth Fund, a nonprofit research group. Compared with benchmarks, the U.S. achieved an overall score of 65 out of a possible 100 across 37 indicators of performance.

Efficiency is a major problem, as well as access to care due to lack of insurance and premiums rising faster than wages. The report notes that in a cross-national survey, 22% of U.S. adults with health problems reported that their test results and medical records were not available at the time of their doctors’ appointments. The Netherlands set the benchmark rate of 9%. U.S. patients were also more likely to say their doctors unnecessarily repeated tests—20% vs. a 4% benchmark, again from the Netherlands. Overall, wasteful or fragmented care, avoidable hospitalizations, variation in quality and costs, slow adoption of EMRs, and soaring administrative costs were blamed for an average efficiency score of 53 out of 100 for the United States (See Graph).