There are painful losing streaks that don't really matter -- say, the Tampa Bay Buccaneers 26-game disaster in 1976 and 1977 -- and losing streaks that really mean something. This one means something. 
 
 A report released Monday by a respected think tank ranks the United States dead last in the quality of its health-care system when compared with 10 other western, industrialized nations, the same spot it occupied in four previous studies by the same organization. Not only did the U.S. fail to move up between 2004 and 2014 -- as other nations did with concerted effort and significant reforms -- it also has maintained this dubious distinction while spending far more per capita ($8,508) on health care than Norway ($5,669), which has the second most expensive system. 
 
 "Although the U.S. spends more on health care than any other country and has the highest proportion of specialist physicians, survey findings indicate that from the patients’ perspective, and based on outcome indicators, the performance of American health care is severely lacking," the Commonwealth Fund, a New York-based foundation that promotes improved health care, concluded in its extensive analysis. The charts in this post are from the report. 
 
 The data for the 2014 report was collected before the Affordable Care Act (aka Obamacare) went into full effect, so that reform may eventually boost the U.S. out of last place by providing health insurance to some of the 50 million people who lacked it. But, according to the study, the problems of our health-care system remain so pervasive that it will take more than better access and equity to resolve them. 
 
 Karen Davis, a professor in the Bloomberg School of Public Health at Johns Hopkins University and lead author of the study, said overall improvement "is a matter of accountability, having information on your performance relative to your peers and being held accountable to achieving a kind of care that patients should expect to get." 
 
 The United Kingdom, which spends just $3,405 per person on health care, placed first overall in the comparison of 11 nations that include Australia, New Zealand, Switzerland, Canada, France, Germany and others. (Previous surveys examined smaller numbers of nations.) In 2004, the U.K. ranked third of the five nations studied. 
 
 "They're not your grandmother's national health service any more," Davis said. 
 
 The U.K. diagnosed its health care system's problems and addressed them, Davis said. "They really have moved up over time. A lot of it has been systematic attention to increasing resources in the system," she said. Officials hired more specialists, gave bonuses to family physicians who meet quality targets and adopted health information systems that allow physicians to easily share information about patients. And everyone has a doctor. 
 
 The United States, on the other hand, "ranks behind most countries on many measures of health outcomes, quality, and efficiency. U.S. physicians face particular difficulties receiving timely information, coordinating care, and dealing with administrative hassles," the report concludes. The U.S. is beginning to catch up as it responds to financial incentives to improve health information systems, and Obamacare should strengthen that effort. 
 
 The U.S. fares well in providing preventive care and patient-centered care, according to the report. But among its many deficiencies, according to Davis and the report, are a relative shortage of primary care physicians; lack of access to primary care, especially for the poor; a large number of low-income residents who skip needed care, do not get recommended tests or do not fill prescriptions because of cost; high infant mortality; inordinate levels of mortality from conditions that could have been controlled, such as high blood pressure; and lower healthy life expectancy at age 60. 
 
 Davis said that while the government can set standards, provide incentives and exact penalties for poor performance, professional organizations that represent various parts of the medical system must get behind the effort to force changes, and many have. ||||| Hospitals make money from their own mistakes because insurers pay them for the longer stays and extra care that patients need to treat surgical complications that could have been prevented, a new study finds. 
 
 Changing the payment system, to stop rewarding poor care, may help to bring down surgical complication rates, the researchers say. If the system does not change, hospitals have little incentive to improve: in fact, some will wind up losing money if they take better care of patients. 
 
 The study and an editorial were published Tuesday in The Journal of the American Medical Association. The study authors are from the Boston Consulting Group, Harvard’s schools of medicine and public health, and Texas Health Resources, a large nonprofit hospital system. 
 
 The study is based on a detailed analysis of the records of 34,256 people who had surgery in 2010 at one of 12 hospitals run by Texas Health Resources. Of those patients, 1,820 had one or more complications that could have been prevented, like blood clots, pneumonia or infected incisions. 
 
 The median length of stay for those patients quadrupled to 14 days, and hospital revenue averaged $30,500 more than for patients without complications ($49,400 versus $18,900). Private insurers paid far more for complications than did Medicare or Medicaid, or patients who paid out of pocket. 
 
 The authors said in an interview that they were not suggesting that hospitals were trying to make money by deliberately causing complications or refusing to address the problem. 
 
 “Absolutely not,” said David Sadoff, a managing director of the Boston Consulting Group. “We don’t believe that is happening at all.” 
 
 But, he said, the current payment system makes it difficult for hospitals to perform better because improvements can wind up costing them money. 
 
 Susan Pisano, a spokeswoman for America’s Health Insurance Plans, a trade group for insurance companies, said in an interview that the study illustrated that the entire health care system needed to move away from what she called “the perverse incentives of the old fee-for-service system that emphasized quantity over quality, and toward methods of payment that reward better care.” 
 
 The researchers say that to help reduce complications, insurers not only should quit paying for substandard care, but also should reward excellent care with bonuses. In addition, hospitals should be required to disclose their complication rates, because patients will shun those with high rates and force those hospitals to improve or shut down. 
 
 Dr. Barry Rosenberg, an author and a managing director of Boston Consulting, said the study came about because his firm was working with Texas Health Resources to find ways to reduce its hospitals’ surgical complication rates, which, at 5.3 percent, were in line with those reported by similar hospitals. Part of that work involved analyzing the costs, and he said the team was stunned to realize that lowering the complication rates would actually cost the hospital money. 
 
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 “We said, ‘Whoa, we’re working our tails off trying to lower complications, and the prize we’re going to get is a reduction in profits,’ ” Dr. Rosenberg said in an interview. 
 
 The authors focused on one particular figure, called the contribution margin, which is an important measure of a hospital’s income and ability to cover its costs. They said that when complications occurred, this measure tripled for patients with private insurance and doubled for those on Medicare. 
 
 Dr. Mark C. Lester, a study author and the executive vice president of Texas Health Resources, said its hospitals had begun to use a checklist system to help prevent complications. Dr. Atul A. Gawande, a Harvard surgeon who is a pioneer in using checklists and who took part in the Texas study, helped develop the system. Surgical checklists involve deceptively simple-sounding practices like double-checking the patient’s identification and what part of the body is being operated on, and making sure that drug allergies have been noted and proper medications given. 
 
 Dr. Lester said it was not clear how low the complication rate could or should go. Zero would be great, but was not realistic, he said. 
 
 As to whether the hospital would lose money if more patients needed less care and went home sooner after surgery, Dr. Lester said, “to us that doesn’t have an impact.” 
 
 “Reducing complications and increasing safety is why we’re there,” he said. “If in doing that, some payments don’t come our way, it’s not of consequence. What’s of consequence is that people who come to us are in a safer environment.” 
 
 Dr. Robert M. Wachter, an expert on medical errors who was not involved in the study, said in an e-mail that Medicare and other payers had tried to encourage better care by refusing to pay for certain kinds of medical errors and cutting reimbursement if too many patients were readmitted or gave the hospital bad marks on patient-satisfaction surveys. But the new study “shows that we still have miles to go,” said Dr. Wachter, the associate chairman of the department of medicine at the University of California, San Francisco. 
 
 Ms. Pisano, of the health insurance group, said Medicare and private insurers were already using a “never list” of things they will not pay for, like leaving a sponge or instrument inside a patient, or operating on the wrong organ or wrong limb. 
 
 In an editorial, Uwe E. Reinhardt, an expert on medical economics from Princeton University, called the study’s findings “troublesome but not surprising.” He called the current payment system “untoward,” adding that it “can tempt otherwise admirable people into dubious conduct.”
– The US health care system is hopelessly broken, blowing $750 billion a year—or about 30 cents of every dollar that goes into it—on unnecessary procedures, paperwork, fraud, price gouging, and other inefficiencies, a new report from the influential Institute of Medicine has concluded. "Health care in America presents a fundamental paradox," the report says. While medical knowledge and technology have taken dramatic leaps, the system "is falling short on basic dimensions of quality, outcomes, cost and equity." The report has been in the works for 18 months, the AP reports. It suggests several reforms, including changing the way doctors are paid to reward results and discourage unnecessary treatments. "We have a lot of medical care that is not helpful," one cardiologist says. But "when you talk about getting rid of any type of health care, someone yells, 'Rationing.'" The report found disturbing things about care quality as well; for example, a third of hospital patients are harmed during their stay.