If the quality of healthcare in every US state in 2005 was the same as that in the best performing state, 75 000 deaths would have been averted, a new report from the Institute of Medicine says.

The report, published on 6 September, says that although the system has seen an explosion in knowledge and technology and now expertly manages once deadly conditions, it is also beset by poor quality care, uneven outcomes, an unhealthy population, and runaway spending.1 The institute, an independent adviser to the government, is part of the National Academy of Sciences.

Its report, drawn up by a group of 18 clinicians, policy experts, economists, and business leaders, also puts a figure on the money wasted in the United States each year through unnecessary services, lost opportunities to prevent illnesses, inefficiencies, and administrative waste: $765bn (£470bn; €580bn), or 30 cents in …