Our country spends more on healthcare than any other developed nation, yet we receive far less compared to others for what we pay. Today, the United States ranks thirty fifth in health outcomes among the 195 nations of the world. When measuring things like infant mortality, maternal mortality, and death under the age of five, the United States ranks well behind all other countries in the Organisation for Economic Co-operation and Development (OECD) and even below Cuba and Slovenia. All that despite spending almost twice as much of our GDP on healthcare as other OECD countries.

Eighteen percent of our GDP goes to health. The amount we spend on healthcare is staggering, in excess of three trillion dollars in 2018 and expected to grow to double that amount by 2027. This far surpasses other discretionary spending, including military spending, infrastructure spending, education spending, and social welfare spending. Profligate spending and poor results. We can do better.

So much of the healthcare debate today centers on how we pay for healthcare services – private insurance, employer sponsored insurance, federal and state payments, single payer systems, or out-of-pocket payments. Too little of our public discourse addresses the concerns of most people: What do we get for what we pay? Does the treatment we receive actually provide the remedy to what ails us? Can we manage the long term consequences of disease? Are our treatments safe or do they expose us to new danger, particularly hospital acquired infections? Is the service patient friendly and convenient? And, yes, is it affordable?

The providers of healthcare services, not the payers, must ultimately answer these questions. It is the providers, hospitals, outpatient facilities, nursing homes, clinics, and home care services that must address the fundamental questions of healthcare outcomes, their safety, convenience, and patient-centeredness. Regulations and payment regimes may guide, but do not determine provider behavior.

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Originally Published on Forbes (August 2, 2019)