Although the US health care system has experienced financial success, an analysis identifying trends in economics, costs and value from 1980 to 2011 reveals that the health care system has underperformed in certain areas, compared with similar countries.
And though the report highlights some improvements in outcomes, the pace of progress is much slower than in past decades.
The analysis was undertaken by Dr. Hamilton Moses III, of the Alerion Institute and the Johns Hopkins School of Medicine, along with colleagues from The Boston Consulting Group and the University of Rochester. Results of the analysis were recently published in JAMA.
The team used publicly available data to analyze the economics of health care, the profile of people who receive care, organizations that provide care, and objective health outcomes and perceptions of care quality.
On the economic front, the investigators found that government funding toward health care increased from 31% in 1980 to 42% in 2011, however, costs have tripled over the past 20 years.
Even though resources devoted to health care have increased, the team found that in several health metrics, including life expectancy at birth and disease survival, the US is behind other comparable countries.
Since 2000, the team found that the price of professional services, drugs, devices and administrative costs – not service demand or an aging population – was responsible for 91% of the cost increases.
Additionally, chronic illnesses were responsible for 84% of overall costs in the entire population, not only in the elderly, the investigators note.
Surprisingly, these chronic illnesses in people under the age of 65 accounted for 67% of spending.
Some good news for individual wallets: personal spending on insurance premiums and co-payments has decreased from 23% in 1980 to 11%.
The investigators found three major factors that have stimulated the most change in the US health care system.
The first is consolidation. The team notes that there are fewer insurers and general hospitals but more specialty clinics and larger physician groups, which has “produced financial concentration in health systems, insurers, pharmacies and benefit managers.”
The second factor is information technology. Though they say that value here is ambiguous, quite a bit of investment has been put into this aspect of health care.
The third factor that has produced the most change is the “patient as consumer.” Patients are becoming more savvy with their health, seeking advice independent of traditional channels. They now look to social media, informal networks, public sources of information and self-management software.
Indeed, the field of self-monitoring, through which patients can track their own health proactively, has seen an expansion recently.
In the wake of all these changes, the team also points to “the development of more systematic management of what remains a highly fragmented system.”
The researchers say that these factors “create a triangle of tension,” whereby patients strive for choice and personal attention, physicians desire professionalism and autonomy, and public/private payers endeavor for economic value across large populations.
The US health system is “struggling to adapt” among these competing desires and expectations, say the investigators, adding:
“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. These contradictory forces are difficult to reconcile, creating risk of growing instability and political tensions.”
They add that this conflict is likely to increase, hindering care integration and halting other favorable changes.
“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.”
The investigators conclude their analysis by suggesting how the US health care system might strive to come together in order to move forward:
“Perhaps a conversation, fully informed by the facts and acknowledging perspectives among those who receive, provide and finance health care, can do better than the political acrimony of the past few years.”