Health care in the United States is a mix of public and private systems. While most healthcare providers are private, many people get insurance at a discount through their place of work. Some healthcare is subsidized by the government through various programs. Taxes and general government revenues help pay for this. Healthcare costs in developed countries are increasing due to new technology and better care. While the government does its part to make health care more affordable for all, costs still remain high.
The focus on quality has led healthcare providers to gravitate towards less controversial measures. Many ‘quality’ measures are not actually gauging the quality of care, but rather capturing compliance with practice guidelines. For example, HEDIS scores are largely comprised of clinical indicators and process measures. For example, diabetes providers measure the reliability of LDL cholesterol checks and hemoglobin A1c levels, but patients care more about risks of vision loss, dialysis, and amputation.
Most countries blend a mix of the five models of health care. The mix varies by country and over time, but the amount of money spent on healthcare is an important question to ask. It is often expressed as a percentage of GDP. Life expectancy is related to health care spending in OECD countries. Bloomberg’s analysis indicates that health care spending is related to life expectancy in many of these countries. However, this is only one measure of health system performance. It’s also hard to argue that more funding makes everything better.
Implementing the value agenda requires a transformation from physician organizations to the health care system. Health care leaders should not cling to a broken system. By continuing to hold onto the current model, providers will quickly become dinosaurs. The current cost structure and prices are unsustainable. The organizations that master the value agenda will be rewarded with financial viability and pride in the value they deliver. So what does the future hold for health care? In short, the question is “Can we afford not to change?”
In order to achieve the goals of value transformation, clinicians must first determine the scope of services they provide. Then, they must determine which service lines cannot achieve high value. Often, community providers will exit service lines that they can no longer afford, while academic medical centers may enter these service lines by establishing partnerships or affiliations with lower-cost community providers. It is critical to limit service lines in order to realize the desired benefits. But how do we move to a value-based system?
The Affordable Care Act (ACA) includes several requirements for health insurance. The ACA requires insurers to offer universal coverage, a primary care physician, and a medical home. It also mandates antidiscriminatory policies and prohibits underwriting based on health status. The law also prohibits annual caps on insurance premiums. The health care system in the United States varies widely by state. The government should increase investment in preventive care and services to decrease the incidence of preventable diseases. By reducing the prevalence of these diseases, the government can avoid high costs of treating the disease in the future.