The health care scorecard released by the New York-based think tank rated 37 measures of American health care on a scale of 1 to 100, with 100 being best. Though American health care is the most expensive per capita in the world, it underperforms its peers by a wide margin.

The health care system fares poorly in its ability to promote healthy and productive lives, scoring a 67. The quality of care also is below average, rating a 71. Poor care for blood pressure and diabetes treatments result in an estimated 20,000 to 40,000 preventable deaths at a cost of $1 billion to $2 billion in avoidable medical costs.

The need for better quality controls was brought home during the past week in Indianapolis, where three premature babies died at Methodist hospital because they were administered an incorrect dosage of a blood-thinning drug.

A spokesman for the hospital, Jon Mills, says the fees for hospital services will not be passed on to the insurer or employer in light of the preventable deaths.

What the health care system lacks in quality it also lacks in efficiency, as the U.S. scored 51 out of 100 on efficiency measures. The fund’s report said that as a share of total health care cost, insurance administration totaled three times more than countries with the most efficient insurance system.

The report said improvement will require a focus on health care quality, not simply cost reduction. The fund also said that chronic illness, which composes a majority of health care costs, should be remedied with a system designed to encourage the management of chronic illness. This is especially important as the population ages.

Attempts to reward doctors for giving patients the right care, following guidelines for certain chronic conditions, are coming to the market. Last week, a collaboration of health care experts announced the launch of Prometheus Payment Inc., a nonprofit payment system that is designed to reimburse doctors for following guidelines for caring for certain cancers; chronic illness such as diabetes, hypertension and depression; interventional cardiology; joint replacement; and routine and preventive care.

Prometheus is intended to minimize a physician’s financial incentive to prescribe unnecessary tests and procedures. It is also aimed at discouraging "capitation," which pays doctors on a per-patient basis and encourages doctors to spend little time and effort on patient care.