Sunday, March 23, 2014

A different perspective?

The October 20th, 2013 blog entry 'So how bad is it (healthcare)?' reprised a 2009 blog entry that tried to catalog some reasons for high U.S. healthcare costs; took issue with the prevailing wisdom that the U.S. is spending so much more than other countries while obtaining poorer outcomes; noted that it had "now become fashionable or de rigueur to criticize various aspects of hospitals and the health care system" (while providing a couple of examples); and referenced a study that 'explained' high health care costs as directly related to items that result from poverty and income inequality - "Thus, while the US spends more than twice as much on health care than the mean of other OECD countries, its greater GDP and higher prices explain most of it, and income inequality offers an explanation for the rest..."  

The study also noted that U.S. spending on social programs appeared to 'mirror' health care spending i.e. they are on the low side compared to other OECD countries by a very similar order of magnitude to which health care costs are on the high side (as demonstrated by the graphic below). This blogger observed that "...this study as of yet has not been picked up and uncritically "megaphoned' by the usual suspects... perhaps because it does not support the current health care zeitgeist."

Next the January 20th, 2014 blog entry 'Add it up...' linked to Time to Act: Investing in the Health of Our Children and Communities. Recommendations From the Robert Wood Johnson Foundation Commission to Build a Healthier America (120-pg PDF), and cited its observation that "In their search for solutions, the Commissioners found that there is much more to health than health care and that where we live, learn, work, and play profoundly influence our health..." (note: underline emphasis mine)

This blogger noticed that a guest blogger at The Incidental Economist has written a book review of a book (The American Health Care Paradox) which looks at the same issue i.e. poor healthcare outcomes despite the 'high' U.S. healthcare spend.

Per the review the book's authors "... took two decades of commonly-used OECD data on healthcare spending, social-services spending, and health outcomes, and tried to make sense of it all.  The key finding is buried a bit in the figure below (click to enlarge):

Look closely and you’ll see that the United States is not exceptional in terms of its total spending on health and social services. But it is exceptional in how little it spends on social services relative to health... In terms of total spending that affects health, America’s actually right in the middle of the pack—implying a gross misallocation of spending: too much spending in health services, and too little in social services. This is the core assertion of the book: implicating the social determinants of health as a central player in the problems of American healthcare..." (note: underline emphasis mine)

A finding that jibes perfectly with the studies referenced above. The book reviewer's conclusion - "... for anyone interested in health policy, especially those who rarely think about the social determinants of health, it’s an important step down the road towards addressing it by reframing the issue with a wider lens..."  - is absolutely right on the mark. However, it remains to be seen if this sensible advice will gain traction in the current political environment. 

This blogger is not optimistic on this count...

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