When Are We Going To Get Serious About Health Care Spending In The United States Robert W. Dubois, MD, PhD
When Are We Going To Get Serious About Health Care Spending In The United States Amitabh Chandra, PhD, MA Malcolm Wiener Professor of Public Policy Harvard University Donna R. Cryer, JD President and Chief Executive Officer Global Liver Institute Glenn D. Steele, Jr., MD, PhD President and Chief Executive Officer Geisinger Health System 2
Concerns About Health Care Spending in the U.S. Are Nothing New Health-care spending set Sharp Rise to soar over Predicted in next decade Health-Care Washington Post 20 February 21, 2017 Spending in 18 Next Decade Can We New York Times 16 Health Spending as a Percent of GDP Control September 15, 1998 Medical Health Care 14 Care Cost Costs? Doubles in 3 12 Years January 1, 1981 10 New York Times September 9,1969 8 6 4 2 0 National Health Expenditure Summary including share of GDP, CY 1960-2016. Available at: https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and- 3 Reports/NationalHealthExpendData/NationalHealthAccountsHistorical.html
Wasteful Spending: Also Not New, but Stubbornly Persistent NEJM 1986 IOM 2013 Health A decrease in unnecessary healthcare services “appear to be slow Affairs , in moving” 2017 Source: “Best Care at Lower Cost: The Path to Continuously Learning Health Care in America.” Institute of Medicine [2013] 4 Image source: http://www.mypeexam.org/wp-content/uploads/2015/03/man-pushing-rock-up-hill-ok-to-use.jpg
There’s a Desire for Innovation… But We’re Running Out of Headroom 20 Health spending as a percent of GDP 18 16 14 12 10 8 6 4 2 0 1960 1963 1966 1969 1972 1975 1978 1981 1984 1987 1990 1993 1996 1999 2002 2005 2008 2011 2014 http://www.massdevice.com/wp-content/uploads/files/story_art/petctmedicalimagingscans3x2.jpg http://www.hdtglobal.com/product/prosthetics/ Photo by Jonathan Zizzo for D Magazine. http://healthcare.dmagazine.com/2015/11/11/irvings-texas-center-for-proton-therapy-treats-its-first-patients/ 5 http://www.hdtglobal.com/product/prosthetics/
We’ve Started Spending Debates in the Past… 2009 1993 1979 6
We Need a New Approach Image source: http://www.sevenquotes.com/insanity/ 7
The New Approach Will Not Be Easy How much and how should health spend be allocated? Affordability Value Willingness-to-pay Specialty care Primary care Budget Impact Ethical Considerations Trade-offs Young Elderly Holistic View Acute treatment Prevention Prioritization Health vs. Non-health Rare diseases Common diseases
What We Need to Do: Acknowledge that these are third rail issues Bring all stakeholders into the dialogue Stop finger pointing Come together Go below the surface to examine issues http://www.blacksunplc.co.uk/content/black-sun/corporate-comms/en/insights/perspectives/a-conversation-with-simon- 9 clow/_jcr_content/image.img.png/1461951810583.png https://media-exp2.licdn.com/mpr/mpr/AAEAAQAAAAAAAAd3AAAAJGE5MTE5M2RkLWYxZGUtNGY2MC1iMzBjLTNkNWNlNWE3MTgzZQ.jpg
Let’s Start the Journey https://commons.wikimedia.org/wiki/File:Desert_road_UAE.JPG 10
When Are We Going To Get Serious About Health Care Spending In The United States Amitabh Chandra, PhD, MA Malcolm Wiener Professor of Public Policy Harvard University Donna R. Cryer, JD President and Chief Executive Officer Global Liver Institute Glenn D. Steele, Jr., MD, PhD President and Chief Executive Officer Geisinger Health System 11
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