NEW YORK: American medical care might be the most expensive in the world, but it is getting increasingly difficult to argue that it is worth every penny. A study that was to be released on Thursday highlights the stark contrast between what the United States spends on its health system and the quality of care it delivers, compared with health care in many other industrialized nations.

The report, the second national scorecard prepared by an influential health policy research group, provides evidence of just how frequently the country falls short of its own standards of care and those of its global peers. While the United States spends more than twice as much per capita on health care as most other industrialized countries, including France, it has fallen to last place among those countries in being able to prevent deaths with timely and effective medical care, according the report by the Commonwealth Fund, a not-for-profit research group in New York.

Access to care in the United States has worsened as more people - about 75 million - are believed to lack adequate health insurance or be uninsured altogether. And within the nation, the cost and quality of care varies dramatically, the report found.

At a time when health care has dominated much of the U.S. presidential campaign, the findings provide increasing support for the idea that the health care system in the United States needs to be fixed.

Both presumptive presidential nominees, Senator John McCain and Senator Barack Obama, argue that the country needs to get more value for its health care money. And while there are sharp disagreements about what changes would be most effective, the discussion is shifting away from a defense of the status quo to a discussion about what steps need to be taken.

"People are now aware that you can do better," said Karen Davis, the president of the Commonwealth Fund. "It's harder to keep deluding yourself or be complacent that we don't have areas that need improvement."

The report assesses the United States on 37 core measures, updating an analysis first done in 2006. It finds little improvement over the last two years, with access to care becoming an increasing problem as the cost of health care continues to rise steadily and more people - even those with insurance - struggle to pay their medical bills. "The central finding is that access has deteriorated," said Davis.

Even some experts quick to point to some of the country's medical successes, as in reducing the deaths from heart disease or childhood cancers, for example, are quick to acknowledge the need for change.

"We need to generate better value in this country," said Dr. Denis Cortese, the chief executive of the Mayo Clinic, who is among many health system executives leading discussions about how to improve the health care system.

In some cases, the nation's progress was overshadowed by improvements in other industrialized countries, which typically have more centralized health systems in which changes are easier to put in place.

Although the United States has reduced its number of preventable deaths for people under 75 years old to 110 deaths per every 100,000, compared with 115 five years earlier, other countries made greater strides. As a result, the United States now ranks last in preventable mortality among developed nations, just below Ireland and Portugal, according to the Commonwealth Fund's analysis of World Health Organization data. The leader by that measure is France, followed by Japan and Australia.

Other countries worked hard to improve their standings, according to the Commonwealth Fund researchers. The United Kingdom, for example, focused on steps like improving the performance of individual hospitals that had been the least successful in treating heart disease.

"It's really making a government priority to get top-quality care," Davis said.

The presidential candidates both emphasize the need to shift the country's health priorities, to provide more medical care that helps prevent people from developing disease and to control conditions before they become expensive and hard to treat.

The mounting evidence that the United States needs to do better indicates the issues are not just talking points by politicians, said Len Nichols, a health economist at New America Foundation, a not-for-profit group in Washington that advocates universal health care coverage. More hospital executives and physicians understand their performance could be better, Nichols said.

The report also emphasizes how inefficient the American health care system can be. The administrative costs of the health insurance system consume much more of the current health care dollars than in other countries. Bringing those administrative costs down to levels in Germany and Switzerland, where private insurers play a significant role, would save an estimated $50 billion a year in the United States, Davis said. "It kind of dwarfs everything else you can do."

Many of the high costs are the result of the lack of computerized systems that might link pharmacies and doctors' offices for filling prescriptions or that might enable insurers to more efficiently pay doctors' bills.

Karen Ignagni, the chief executive of American's Health Insurance Plans, the industry's trade group, argues that many of the higher administrative costs stem from the additional services provided by United States insurers, like disease management programs, and the burdensome regulatory and compliance costs of doing business in 50 states. A more uniform system could result in savings, she said.

Few would disagree that the report indicates how interrelated the issues of access, cost and quality are. High costs limit access to medical care, which results in worse health problems, driving up costs.

Other countries are able to tackle these issues more effectively, said Cathy Schoen, senior vice president for research and evaluation for the Commonwealth Fund.

"They are able to do more with a lower level of expenditure," Schoen said, "and they keep getting improvements."