What is Really Wrong with U.S. Health Care Today

What is Really Wrong with U.S. Health Care Today

Written by Harry R. Jacobson, M.D. Vice Chairman and Chief Medical & Science Advisor.

This is the first in a series of blogs on the so called “US Health Care System.” The goal is to understand why we pay so much and do not achieve the outcomes that are possible. The US health care industry is huge and complex. Not surprising for an industry that employs one out of every 9 individuals employed in the US and that consumes $5 trillion a year, rising at a rate higher than general inflation and approaching 18% of the entire US GDP.

So, where and how do you begin to look for why we pay so much (more than 2X the rest of the industrialized world ) and do not achieve close to the best health outcomes? We do not even rank in the top 20 countries for health outcomes or longevity. While the focus will largely be on the health care services sector, it is helpful to divide the health care industry into 5 major sectors as each plays a role in how the services sector performs:

1) Services: includes hospitals, outpatient settings ( like surgery, imaging, dialysis ), physicians, nurses, and all other provider professionals;

2) Information Technology: includes business and clinical solutions as well as Artificial Intelligence

3) Medical Technology: includes devices, diagnostics, equipment, and supplies

4) Insurance and Managed Care: includes private and public (Medicare, Medicaid, ACA ) plans, but also including benefits management like pharmacy benefits management

5) BioPharma: from small molecule drugs to biologic therapeutics.

To get started we need to first answer what some might think is a simple question but likely the most important question to ask if we are to create innovative “fixes” and that is “What is the job of the health care services sector?” The answer, simply put, is to translate science into practice efficiently and effectively. The two “e” words are critical
since today we are not nearly as efficient and effective as our tools and evidence would enable. Because of scientific research (funded over decades by the NIH and private corporations) today we have amazing assets available to prevent, diagnose, and treat disease. I am referring to the drugs, the medical devices, and the diagnostic tools at our
disposal. Very importantly, because of the massive number of published well done clinical trials, we have evidence on how best to deploy what science has provided.

If my definition of the “job” is reasonable then the obvious next question is “How are we doing?“ To help answer that question it is very useful to drill down on what is meant by the term “job “ and break it down into its major components. In other words, create a practical model that can be used to focus on opportunities to improve performance. My next blog will describe that model in detail.