US Health Care Debate: Spending More, Getting Less

We have huge debates, don't we, surrounding healthcare spending, healthcare expenditures, cost of our healthcare system, and the value proposition of exactly what is it delivering in terms of patient health outcome. And that fire was fueled and stoked even greater with the publication of this series of papers that just appeared in the Journal of the American Medical association with the provocative title Healthcare Spending in the United States and Other High Income Countries in in which it demonstrated. This is again JAMA, March 13, 2018, in which they point out that there are several takeaways from this exhaustive evaluation of healthcare expenditures in the US versus other developed countries. And those were that United States has about twice the per capita healthcare expenditures any of the other developing countries. And those healthcare expenditures are not related to increased utilization. They're related to increased per transaction cost because of overhead, because of administrative fees, because of certain margins of profit in the way of therapeutics like pharmaceuticals. And therefore it's a cost related, not a utilization related issue. So you might say, oh well, okay, there is something that we can get our hands on. We can talk about how we're going to improve the cost efficiency of our healthcare system so that we can get the per capita head cost down for healthcare delivery. But there's more than this. And what's more than this is not only did we have twice over twice the healthcare expenditures per capita, but we had lower outcome of success in the value proposition of performance. So we were spending more and getting less. And in fact, I think that second point is a very important point. Are the therapeutics that we're using not only more expensive, but are they less successful than if we did something else which might have even been less expensive? And I might add that probably the most cost effective way of dealing with this is the way that many other of the more developed countries are dealing with this. And that is a different patient engagement. Not only are we seeing the improvement in cost effectiveness by lowered expenses for administrative fees and profit, but we're seeing a different delivery of a relationship of healthcare in terms of the services, more patient centered, more focused on things that really patients can modulate and modify and control and are very important in their successful outcome, which, which has to do with personalized lifestyle healthcare. We are witnessing a transformation. It's as if the emperor has no clothes and we've been kind of living with it for some time, not wanting to say anything. And suddenly now all the data which is extensive, is coming out to say spending more, getting less. Not only do things cost more, but you're doing the wrong things that cost more. You should be doing something else. And that is where I believe the paradigm shift and the revolution is going to occur as we start to do the right things, which will turn out to also cost less and get the patient more engaged in their own health in ways that are going to produce a meaningful outcome across the burden of these chronic illnesses that constitute more than 70% of our health care expenditures. So data is strong. You can read this whole report in jama. It goes on to really talk in the editorials. In fact, there's a wonderful editorial entitled Challenges in Understanding Differences in Health Care Spending between the United States and Other High Income Countries. And this editorial goes through exactly what I'm talking about. Spending more, getting less, because we're doing the wrong things. We need to change the system, change the way we think about chronic illness, change the nature of the patient engagement, change the tools that we're using, and also change the cost effectiveness of the way it's delivering by reducing the burden of excessive administrative fees and institutional setting fees, which are really not the most germane for getting positive outcome. So the data is here now. What are we going to do with it?