Pouring resources into an inefficient healthcare system?

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:

U.S. Ranks 50th out of 55 Countries in Health Care Efficiency

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.

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2 thoughts on “Pouring resources into an inefficient healthcare system?

  1. I just want to start by saying that I know very little about the Affordable Care Act. Consequently, I have a fairly neutral perspective. That being said, I feel the ACA was successful in enrolling more citizens for insurance. The article quotes Obama, saying that 20 million people gained insurance as a result of this act. That’s an incredible amount. This has supposedly benefited the nation economically, because insured individuals are shown to spend more on health services than uninsured. On the other hand, I think this act can breed inequality and inequity. Those insured under Obamacare are restricted in terms of length of hospital stay, necessity of procedure, etc. As a result, lower-income citizens are being forced to invest in medical services that they have limited control over. High-income individuals, on the other hand, have a greater sense of control about their receipt of various health services. I think it would be very interesting and beneficial to interview low-income individuals about their being required to enroll in the Marketplace. Obtain insurance or be fined. They had no choice really. This is the US being paternalistic; officials believing they know what is best for individuals. At what point does this violate an individual’s right to decide?

    I think you also bring up a very good point as well. This report evaluates the first year of ACA implementation, but the ACA hasn’t been employed long enough to impact life expectancy. Change will be realized in the long-term, but our political organization impedes our ability to implement and consistently evaluate effects over periods longer than 4 years.

    Lastly, this report emphasizes that the United States is one of the top health care spenders in the world. Our nation’s average life expectancy, however, does not reflect this. I think a barrier preventing improvement is our nations unwillingness to look to others as an example. Historically, the US has had a paternalistic role in the global community. Switzerland and Norway spend an amount on health care similar to the US; yet, their national life expectancies are longer on average. I understand that our population demographics may differ and our underlying issues may need more work. but I think we are essentially doomed until we stop being so stubborn and consider the policies other nations have found successful.

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  2. I agree with Kallie’s comment about Obama Care or the ACA. While it is true that it increase the number of people who are insured by a large amount, it does not give them a choice in term of spending money. On one hand, it forces people to get insurance or get penalty, on the other hand, it give them the insurance premium that they can barely use (due to high deductible and limited network). So I would argue that, while the ACA ensure that more people will be insured in case of critical condition it also give the poor people an addition financial burden to bear. As a result the question whether the ACA is beneficial or not is a complex and hard question. The program needs time to be fully evaluated, modified and achieve its goal. In any case, I still think that ACA is a good step, not an optimal step yet, toward fixing the inefficient health care system of US.

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