The U.S. Healthcare System: Challenges and Opportunities

Global Social Welfare, 2016

Shaped by the institutions, ideas, and interests that drive American policymaking, the US health care delivery system is uniquely complex, costly, and unequal. Initially private, it has become an increasingly complex public/private mix, as incremental reforms adopted over many decades have sought to correct market failures to finance and deliver health care services to vulnerable populations, particularly segments of the low-income demographic. While successive reforms have led to better coverage and access over time, they are unlikely to lead to universal access due to their inability to reduce, or even contain, costs over the long run.

Journal of Family Medicine and Health Care, 2020

Background U.S. healthcare spending will reach 20% of GDP by 2026. Despite this spending, almost 14% of our under-65 population still lacks health insurance and out-of-pocket healthcare spending is high. To date, much of the healthcare reform debate has focused on who pays-the government, employers or individuals. Objective To review current healthcare reform issues and evidence. Method We address the questions of how much we pay, how we pay and what we receive for the money as a potential foundation for constructive dialogue. Results U.S. healthcare spending continues to exceed that of other countries, without offering universal coverage. Notwithstanding coverage expansions implemented under the Affordable Care Act, uninsurance rates have been rising. Rapid growth of high deductible plans has also significantly increased rates of underinsurance. There is very little evidence that specific policies or interventions employed to date will significantly reduce cost, especially under a fee for service system, where volume makes up for cuts. Global risk payments hold the greatest promise for real cost containment because they can drive true delivery system reform. Conclusion Meaningful, long-term healthcare reform cannot be successful until comprehensive, evidence-based policies that address healthcare costs are fully embraced and implemented.

In a 2002 commentary in Health Affairs, Joseph P. Newhouse observed, "Medical care seems to obtain less value from the resources it uses than other industries do, a phenomenon not limited to the United States." 1 Many groups, from the Kaiser Family Foundation to the Congressional Budget Office, 2, 3 have noted that the swift adoption and diffusion of expensive new devices, drugs, and procedures is a major factor driving both medical progress and growth of health care spending. What distinguishes innovation in health care from other industries is that adoption of new technologies is largely insulated from concerns about cost. ■ Rapid adoption of expensive health care technology is a major contributor to spending growth. ■ Payment policies that reimburse new technologies, irrespective of their cost, favor development of expensive innovations over those that might produce equal or greater benefit at lower cost. ■ Health information technology has not achieved its full potential, but its benefits should grow over time. ■ Because health care is largely regulated at the state level, the states can play a valuable role as "laboratories" for innovative policies.

Cadernos de Saúde Pública, 2016

Health Informatics on FHIR: How HL7's New API is Transforming Healthcare, 2018

The US Healthcare System 2.1 Introduction This chapter briefly describes the US healthcare system and some of the most important of its many problems. This is a complex topic that I cannot adequately cover in a short, introductory book, so I have provided a number of suggested supplemental readings. For a very complete and detailed discussion of the topics raised here (and others) I suggest the Institute of Medicine 1 publication The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary which is available for purchase or free download. 2 Some readers may wonder why I devote an entire chapter to a topic filled with structural, policy, economic and even political issues in what is, after all, a health informatics book. Based on my prior experience, I know that many readers may have little background in the US healthcare delivery system. My distinguished former Georgia Tech industrial engineering colleague, Dr. William Rouse, describes US healthcare as a complex adaptive system. Paraphrasing him, such a system is (a) nonlinear and dynamic and does not inherently reach fixed-equilibrium point so it may appear to be random or chaotic and (b) composed of independent agents whose behavior is based on physical, psychological, or social rules rather than the demands of system dynamics. Because agents' needs or desires are not homogeneous, their goals and behaviors are likely to conflict. In response to these conflicts, agents tend to adapt to each other's behaviors. Agents are also intelligent so, as they experiment and gain experience, agents learn and change their behaviors accordingly. Thus overall system behavior inherently changes over time and may range from valuable innovations to unfortunate accidents. An article in the January 11, 2006 NY Times provides a clear

Journal of Law Medicine & Ethics, 2023

T he United States needs an efficient, effective, and politically feasible way to provide all Americans with access to affordable healthcare. We propose a new healthcare system named "Comprehensive Healthcare for America" (CHA). The 2021 report of the Commonwealth Fund on the performance of the US healthcare system compared to those of 10 other high-income countries is damning. Even with the Affordable Care Act (ACA), the US ranks last in access to care, equity, administrative efficiency, and healthcare outcomes. As a result, it ranks far below all the others in overall performance, despite vastly higher spending. The American public agrees: in the West Health-Gallup survey in June 21-30, 2022, 44% gave the health system a grade of D or F. What can be done? An obvious solution would be a single payer system, an expanded and improved "Medicare for All," long advocated by Physicians for a National Health Program. It would provide universal access and comprehensive benefits, would be equitable, and would reduce administrative barriers and costs. The Medicare for All bills of Bernie Sanders in the Senate and Pramila Jayapal in the House of Representatives would, after a 2-4 year transitional buy-in period, institute automatic enrollment for everyone (except for those insured by the Department of Veterans Affairs and the Indian Health Service). 3 This solution would be in line with the health systems of other high-income countries, which provide universal health insurance -generally considered a right -through either single payer systems or mixed systems with considerable governmental control.

This report analyzes the health reform bill passed by the U.S. House of Representatives and the reform provisions under consideration in the Senate that would affect providers' financial incentives, the organization and delivery of health care services, investment in prevention and population health, and the capacity to achieve the best health care and health outcomes for all. The bills represent a pragmatic approach to closing the gaps in insurance coverage by: building on a mix of employer coverage, other private plans, and a public plan in a health insurance exchange, or exchanges; strengthening Medicare; and expanding Medicaid. Even under current estimates, 18 million to 24 million people will remain uninsured, however, and many others will still face financial barriers to obtaining needed care or hardship in paying premiums or medical bills.

2010

A comprehensive health care reform bill was passed by the U.S. Congress and signed into law by President Obama on March 23, 2010. In this brief paper, we attempt to convey the existing structure of the U.S. health care system, to identify its major weaknesses, to describe the primary new features introduced by the act, and to offer our overall appraisal of the reform. Today’s pre-reform U.S. health care system produces a huge volume of services—as of 2007, expenditures had reached $2.2 trillion or 16.2 percent of the nation’s GDP. These services are often distributed inefficiently and inequitably, and both per capita costs and total cost relative to GDP exceed those of other developed nations. The health care reform includes expansion of the Medicaid program (in 2014) to cover everyone with income below 133 percent of the federal poverty line; and those with low to moderate incomes will receive subsidies to achieve increased coverage and access. By 2014, private insurers will no lon...

Social Science & Medicine, 1995