The Real Reason American Healthcare Struggles, And What to Do About It

At the American College of Healthcare Executives’ 57th Congress on Healthcare Leadership, Susan Dentzer, senior policy advisor at the Robert Wood Johnson Foundation, asked attendees to imagine a country with an economy about the size of France, with $2.8 trillion in gross product. In this country, life expectancy is below that of the world’s 28 richest countries. Eighty percent of adults are expected to be overweight or obese in six years. As people become ill, they are treated with “medical care,” but up to half of that care has no evidence behind it to suggest it works. And, one of the top 10 causes of death — and by some estimates, the top 3 — is due to adverse events that occur as patients receive medical care.
What is this country? “The United States of Healthcare,” said Ms. Dentzer, and it is ripe for transformation. America’s healthcare system is in need of transformation — one that leads to a healthier population, higher quality care and lower costs.
What will it take to get there, and what roles with hospitals and health systems play? To answer those questions, Mr. Dentzer said we should examine another question: Why is our country is so far behind others? The answer, she says, is something that isn’t a mystery.
“Other countries have a much higher ratio of social spending to healthcare [spending]; we are the outlier,” she said.
According to the Institute of Medicine and others who have studied factors that determine population health, the areas where hospitals focus a great deal of their efforts (counseling, education and clinical interventions) have a relatively small impact on community health.
A recent IOM workshop report on population health uses the community-wide health impact pyramid (pictured below) to better understand the key determinants of population health.
 
As shown on the pyramid, socioeconomic factors and transitioning individuals to healthier “default” behaviors hold the most promise for achieving what Ms. Dentzer refers to as “achieving the potential of health system transformation.”
What does this mean for health systems? Well, for one, the key to population health success involves carrying out activities that have traditionally not been performed by the traditional health system. The most successful health systems, then, are likely to have well developed groups that function essentially as a private public health department within the larger integrated organization.
If taking on responsibilities for public health services (e.g., helping people find reliable housing, providing job training, encouraging exercise, developing campaigns to end domestic violence, etc.) seems outside the realm of the traditional health system, it is. But it’s just what health systems must do if they are to succeed.