“Individuals’ demand for medical care is potentially boundless, but the collective systems that fund most health care must impose limits. That contradiction is a growing problem for rich countries as costs spiral upwards.” - Paul Wallace [1]
Undoubtedly, escalating healthcare costs represents one of the most pressing social challenges that the United States currently faces. Obesity, diabetes, heart problems, and chronic diseases abound throughout America’s communities, and these pervasive health maladies strike more and more citizens every day (and, unfortunately, affect ever-increasing numbers of youth as well). As a result, demand for medical services continues to rise. Couple this disease management and treatment demand spike with aging population demographics and exponential growth in expensive (often prohibitively expensive) medical technologies for procedures and tests, and a resource constrained healthcare delivery system seems like a likely state of affairs.
Right now, America’s wealth acts as a double-edged sword: on one hand, Americans can afford to spend more money on healthcare; however, on the other hand, Americans can afford to spend more money on healthcare! In fact, according to Victor Fuchs of Stanford University, “higher income often seems to do as much harm as good to health” [1]. Diminishing returns on healthcare expenditures (life-preserving angioplasty procedures, for example) set in much more slowly than they do for other goods and services (cars, for instance); therefore, as Americans’ incomes increase, their choices to spend more on healthcare reflect, at some level, individuals’ decisions to place high premiums on medical care as a way to restore, maintain, and enhance their health states. Notably, David Cutler of Harvard University “estimates that an extra year of life is worth $100,000 to an individual” [1]. This dynamic creates a challenging situation for America’s healthcare system: more and more poor health and chronically ill Americans demand ever more healthcare resources from a provider system that has the capability to treat and preserve life using extremely advanced and expensive medical technologies and procedures.
Thus, where do we, as a society, draw the line on how much of our national income we should devote to medical expenses? Given that health insurance is not and does not guarantee healthcare access, let alone quality care, and that healthcare access does not guarantee beneficial outcomes, nor, ultimately, health (iatrogenic illness occurs in up to thirty percent of medical cases), healthcare leaders, providers, policy experts, consumers, and others must engage conversations to determine how best to spend our nation’s income. If preserving, maintaining, restoring, and enhancing the health of our nation’s citizens represents the primary goal of our healthcare delivery system -- which, from a public health perspective, seems like an appropriate goal -- then we must confront the reality that this interpretation of “healthcare” has far-reaching implications from a public policy point-of-view. The central question that follows logically from this public health policy conclusion is clear: Does more spending on medical care actually provide our nation’s citizens with the greatest return on investment in terms of achieving health? Most likely, the answer, at the margin, is no. Yet, how do we, practically and ethically, control or influence individuals’ choices to spend their resources on their health as they see fit? This is the decision-making and operational conundrum that our healthcare system currently faces; how best to move from here is highly uncertain. ...
... The system needs more social experiments to uncover what works.
Hello Health is one emerging bottom-up tinkering innovation that we so desperately need.Reference [1] “The health of nations.”
The Economist (2004), after page 50.
Undoubtedly, escalating healthcare costs represents one of the most pressing social challenges that the United States currently faces. Obesity, diabetes, heart problems, and chronic diseases abound throughout America’s communities, and these pervasive health maladies strike more and more citizens every day (and, unfortunately, affect ever-increasing numbers of youth as well). As a result, demand for medical services continues to rise. Couple this disease management and treatment demand spike with aging population demographics and exponential growth in expensive (often prohibitively expensive) medical technologies for procedures and tests, and a resource constrained healthcare delivery system seems like a likely state of affairs.
Right now, America’s wealth acts as a double-edged sword: on one hand, Americans can afford to spend more money on healthcare; however, on the other hand, Americans can afford to spend more money on healthcare! In fact, according to Victor Fuchs of Stanford University, “higher income often seems to do as much harm as good to health” [1]. Diminishing returns on healthcare expenditures (life-preserving angioplasty procedures, for example) set in much more slowly than they do for other goods and services (cars, for instance); therefore, as Americans’ incomes increase, their choices to spend more on healthcare reflect, at some level, individuals’ decisions to place high premiums on medical care as a way to restore, maintain, and enhance their health states. Notably, David Cutler of Harvard University “estimates that an extra year of life is worth $100,000 to an individual” [1]. This dynamic creates a challenging situation for America’s healthcare system: more and more poor health and chronically ill Americans demand ever more healthcare resources from a provider system that has the capability to treat and preserve life using extremely advanced and expensive medical technologies and procedures.
Thus, where do we, as a society, draw the line on how much of our national income we should devote to medical expenses? Given that health insurance is not and does not guarantee healthcare access, let alone quality care, and that healthcare access does not guarantee beneficial outcomes, nor, ultimately, health (iatrogenic illness occurs in up to thirty percent of medical cases), healthcare leaders, providers, policy experts, consumers, and others must engage conversations to determine how best to spend our nation’s income. If preserving, maintaining, restoring, and enhancing the health of our nation’s citizens represents the primary goal of our healthcare delivery system -- which, from a public health perspective, seems like an appropriate goal -- then we must confront the reality that this interpretation of “healthcare” has far-reaching implications from a public policy point-of-view. The central question that follows logically from this public health policy conclusion is clear: Does more spending on medical care actually provide our nation’s citizens with the greatest return on investment in terms of achieving health? Most likely, the answer, at the margin, is no. Yet, how do we, practically and ethically, control or influence individuals’ choices to spend their resources on their health as they see fit? This is the decision-making and operational conundrum that our healthcare system currently faces; how best to move from here is highly uncertain. ...
... The system needs more social experiments to uncover what works.
Hello Health is one emerging bottom-up tinkering innovation that we so desperately need.
Reference
[1] “The health of nations.” The Economist (2004), after page 50.