If performance were improved in key areas, the nation could save an estimated 150,000 lives and perhaps as much as $100 billion annually, the report's authors concluded.

Given that the United States spends more on health care than any other country, it should be doing better, said Cathy Schoen, senior vice president of the Commonwealth Fund.

If health care providers increased the proportion of patients who have their diabetes and high blood pressure under control, as many as 40,000 deaths per year could be prevented at a savings of at least $1 billion, according to the National Committee for Quality Assurance.

• Six years after a landmark report on medical errors, the United States still lacks an error-reporting system to assess safety. In the past two years, one-third of patients reported a medical, medication or lab test mistake.

• The mortality rate among black Americans is significantly higher at infancy and for those with heart disease or diabetes. Black people also have considerably lower rates of cancer survival.

The report's authors urged the nation's political and policy leaders to advance changes that would improve efficiency, accuracy and affordability, but they did not endorse specific legislative or regulatory proposals.

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