We know that the U.S. spends more than any other country on healthcare and yet has health outcomes that measure in the low middle of the pack among industrialized nations. We have learned about payment reform efforts seeking to improve quality and contain costs (part of the IHI’s “Triple Aim”). Will it be enough? A PHS 795 student writes:
Lisa Du, in reporting findings from Bloomberg’s Health-Care Efficiency Index (2014), reports, “America was 50th out of 55 countries in 2014, according to a Bloomberg index that assesses life expectancy, health-care spending per capita and relative spending as a share of gross domestic product. Expenditures averaged $9,403 per person, about 17.1 percent of GDP, that year — the most recent for which data are available — and life expectancy was 78.9. Only Jordan, Colombia, Azerbaijan, Brazil and Russia ranked lower.”
This is significant when considering the impact that the healthcare system has on the U.S.’s GDP/GNP. The article notes that the time period of the report covers the first year of implementation for the Affordable Care Act, but, as a long term program, the effects of the ACA couldn’t have affected life expectancy yet. However, it does have significant impact on the GDP. The thought schema here is that if we know that those insured spend more of healthcare services than those whom are uninsured, then by providing mass coverage, the overall consumer expenditures for health-related services would increase. This rationale is purely economic and categorizes ethical implications secondarily, though not necessarily lesser.
I would add that part of the concern is that the uninsured may be underinvesting in healthcare at periods in their lives when they could have a positive impact on quality of life and reducing future expenditures. The problem is that we need to have a long time horizon — but our political time horizon is just 2-4 years.