Improvement in Health Care Outcomes Has Slowed in
U.S. Finds Major Study
Included: economics of health care; people who
receive care and organizations that provide care; value created in terms
of objective health outcomes and perceptions of quality of care;
potential factors driving change, including consolidation of insurers
and health systems; the patient as consumer - see
12, 2013 – An examination of health care in the U.S. finds that despite
the extraordinary economic success of many of its participants, the
health care system has performed relatively poorly by some measures; and
that outcomes have improved, but more slowly than in the past and more
slowly than in comparable countries, according to an article in the
November 13 issue of JAMA,
a theme issue on critical issues in U.S. health care.
U.S. spends 50 percent more of GDP on health
care, yet life expectancy growing slower here than in other countries;
much higher medical costs and worse outcomes; aging population not cause
costs - see video
Hamilton Moses III, M.D., of the Alerion Institute,
North Garden, Va., and the Johns Hopkins School of Medicine, presented
the article at a JAMA media
briefing at the National Press Club in Washington, D.C.
Dr. Moses and colleagues from The Boston Consulting
Group and University of Rochester, using publicly available data,
conducted an analysis to identify trends in health care, principally
from 1980 to 2011.
The areas they addressed included the economics of
health care; the profile of people who receive care and organizations
that provide care; and the value created in terms of objective health
outcomes and perceptions of quality of care. In addition, they examined
the potential factors driving change, including consolidation of
insurers and health systems; health care information; and the patient as
Among the findings:
• In 2011, U.S. health care employed 15.7
percent (21 million people) of the workforce, with expenditures of $2.7
trillion, doubling since 1980 as a percentage of U.S. gross domestic
product (GDP) to 17.9 percent.
Between 2000 and
2010, health care increased faster than any other industry (2.9
percent/year) but trailed government (3.3%/year); health’s proportion of
GDP doubled between 1980 and 2011. Government funding increased from 31
percent in 1980 to 42 percent in 2011. Costs have tripled in real terms
over the past 2 decades. However, the average rate of increase has
declined consistently since the mid-1970s and sharply over the last
• Despite the increases in resources
devoted to health care, multiple health metrics, including life
expectancy at birth and survival with many diseases, shows the United
States trailing peer nations.
In addition, the
researchers note that findings from their analysis contradict several
• Price of professional services, drugs
and devices, and administrative costs, not demand for services or aging
of the population, produced 91 percent of cost increases since 2000.
out-of-pocket spending on insurance premiums and co-payments have
declined from 23 percent to 11 percent since 1980.
• In 2011, chronic illnesses account for
84 percent of costs overall among the entire population, not only of the
elderly. Chronic illness among individuals younger than 65 years
accounts for 67 percent of spending.
The authors add
that three factors have produced the most change:
• Consolidation, with fewer insurers and
general hospitals (but more single-specialty hospitals and large
physician groups) has produced financial concentration in health
systems, insurers, pharmacies, and benefit managers;
• Information technology, in which
investment has occurred but value is elusive;
• The patient as consumer, whereby
influence is sought outside traditional channels, using social media,
informal networks, new public sources of information, and
forces create a triangle of tension among patient aims for choice,
personal attention, and unbiased guidance; physician aims for
professionalism and autonomy; and public and private payer aims for
aggregate economic value across large populations.
“Measurements of cost and outcome (applied to
groups) are supplanting individuals’ preferences. Clinicians
increasingly are expected to substitute social and economic goals for
the needs of a single patient.”
The researchers write that at the highest level,
the U.S. health system is struggling to adapt to competing goals,
desires, and expectations -
“The conflict among patient desires, physician
interests, and social policy is certain to increase. Those tensions will
likely become a palpable force that may hinder care integration and
inhibit other changes that favor improved outcome and savings. The usual
approach is to address each constituency in isolation rather than
optimizing efforts across them. The triangle will need to be reconciled.
This is the chief challenge of the next decade.”
“A national conversation, guided by the best data
and information, aimed at explicit understanding of choices, tradeoffs,
and expectations, using broader definitions of health and value, is
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