The United States has received a score of 65 from the National Scorecard on U.S. Health System Performance program, down from 67 in 2007.

The Commonwealth Fund, New York, which runs the program, has set the maximum score at 100.

“We lead the world in spending and we should be expecting much more,” says Cathy Schoen, research director at the Commonwealth Fund.

A team led by Schoen came up with the score by looking at indicators for health care quality, health care access, health care efficiency, health care equity and “healthy lives.”

The access indicator dropped to 58, from 67, the researchers report.

In 2007, 42% or 75 million working-age adults, were either uninsured or underinsured, and 33% of U.S adults reported going without needed care due to costs, the researchers note.

The only indicator to show improvement, efficiency, increased to 53, from 52.

Use of electronic medical records increased to 28% in 2006, from 17% in 2001 – but some countries say 98% of their physicians use electronic medical record systems, the researchers report.

Karen Davis, president of the Commonwealth Fund, recommended that the next president further increase efficiency by investing in health information technology.