Debunking the oft-heard cliché that “the United States has the best health care system in the world,” Ezekiel Emanuel, M.D., LDI senior fellow and associate professor of global initiatives at the University of Pennsylvania, told an audience at the University of Pennsylvania's annual lecture. Ta. A series about how many U.S. medical institutions are failing patients and exhausting clinicians.
Emanuel said that while U.S. health care leads the world in achieving five-year breast cancer survival rates, this metric is a rare outlier in the country's overall performance in other areas of health care delivery. He said there is. He also noted that a recent study found that a majority of Americans rate the quality of health care as “substandard,” with 21% (the highest in 20 years) rating the quality of health care as “poor.” He also mentioned the Gallup poll.
Inexorably rising costs
Meanwhile, system costs continued to rise. Currently, health spending is $4.7 trillion a year, which is more than the gross domestic product (GDP) of both Germany and Japan, said Emanuel, speaking at the Charles C. Leighton 2024 LDI in the Wharton School's Huntsman Hall. He spoke at a commemorative lecture by Dr.
In the population health field of preventive care and treatment of hypertension and diabetes, “we do a miserable job with diseases that are not very complex,” Emanuel said. He went on to paint a vivid picture of why the U.S. health care system needs to make dramatic changes to its organization and operations.
Emanuel, an LDI senior fellow and co-director of the Penn Institute for Healthcare Transformation, is also a special advisor to the director general of the World Health Organization (WHO). He served as special adviser for health policy at the White House from 2009 to 2011, and he was one of the architects of the Affordable Care Act (ACA).
“Creative rejuvenation”
Among other accomplishments, Emanuel has written 14 books, the last of which was an analysis of the best and worst health care systems across the developed world. His Leighton Lecture presentation focused on the research he is currently conducting for his soon-to-be-published 15th book, Creative Rejuvenation: New Lens for Transforming American Health Care.
Many of his presentations argued for why dramatic changes are needed across the fragmented and highly complex U.S. health care delivery system.
- The infant mortality rate is 5.5 per 1,000 live births. Of the 49 countries reporting to the Organization for Economic Co-operation and Development (OECD), 36 have lower infant mortality rates than the United States. The United States has three times the infant mortality rate of the best-performing countries, such as the Netherlands and the Netherlands. Norway.
- The maternal mortality rate is 32.9 deaths per 100,000 live births, and the mortality rate for African American women is 2.6 times that of white women and Hispanic women. On average across OECD countries, there are 9.8 maternal deaths per 100,000 people.
- Beyond the aforementioned high blood pressure and diabetes, U.S. health care also underperforms in heart care, stroke, chronic kidney disease, obesity, and avoidable mortality.
A tangle of incompatible programs
For the past 80 years, a major obstacle to care efficiency and cost control has been the 10 was the creation of a separate system. (CHIP), Department of Veterans Affairs (VA) Coverage, TRICARE, Indian Health Service, Federal Employee Health Benefits, ACA Exchange, and his ACA Medicaid Expansion.
Over the decades, each time a new population group was targeted, an entirely new program was created, greatly increasing the complexity and fragmentation of the overall system. This was done rather than expanding existing programs to include new groups into a system of standardized policies, procedures, and practices in both care delivery and payment.
“I was there for the passage of the Affordable Care Act and the expansion of Medicaid,” Emanuel said. “Eligibility requirements don't match the incomes we use. Benefit levels don't match. Fragmentation and complexity reduce the amount of time, effort, and effort it takes for people to understand what they're eligible for. Increased cognitive load. ACA Exchange customers have an average of 113 plan options to choose from. The average Medicare beneficiary has 60 different Part D plans. , you know that having too many choices can be paralyzing. What happens when you have too many choices? Bad choices.”
stir up resistance to institutional reform
Emanuel continued, “Complexity drives waste and inefficiency throughout the system. Multiple prices are expensive to manage and require a lot of effort to meet all the different requirements.” , I argue that institutionalizing fragmentation and complexity creates and strengthens structures that resist any institutional reform.”
In addition to the confusion of incompatible payment systems, fragmentation and complexity negatively impact quality metrics. “Every insurance company, exchange, and regulator has their own quality metrics. Take Medicare as an example. Medicare uses 788 different quality metrics across 34 programs. Single payer There is also fragmentation within the country. Now they are trying to reduce it. It will be a very important effort, but it will take a long time,” Emmanuel said.
“Complying with various quality metrics increases administrative costs and creates inefficiencies,” he continued. “I would argue that this also exacerbates clinician burnout. Mass burnout is occurring. By 2023, more than 50% of physicians and nurses will be burnt out. The study found: If you look at all the different causes that medical professionals rank, number one is administrative tasks. They need to do more and comply with more. In fact, U.S. physicians spend at least 50% more time on electronic medical records than Europeans because they spend more time on billing.”
creative destruction doesn't work
“So how do you cure this kind of sclerosis?” asked Emmanuel. “Well, a business theorist would say “creative destruction.” This is a market process in which innovation makes old ways of doing things obsolete. New producers fundamentally reinvent the structure of business processes, constraining and replacing old ways of doing things. Consider electric cars replacing cars, digital cameras replacing film, personal computers replacing mainframe computers, and, inevitably, internal combustion engines. Creative destruction can occur in business, but not in social systems such as healthcare, education, taxes, and housing policy. You can't just level the playing field and replace it with anything else. So I don't think we can break the path to a better health care system. ”
“My question,” Emanuel said, “is whether some form of creative rejuvenation could be a different way of thinking about it in medicine.” Is it possible to enact comprehensive structural reforms that do not destroy but replace them with new institutional arrangements that solve persistent problems through some kind of rejuvenation process?”
success of other countries
“So look at the Netherlands, Germany, Switzerland. They have multiple insurance companies, but they don't have the problems that we do. How do they do it? What we don't have is universal health care. “They have government mandates that standardize benefits, deductibles, copays, quality metrics, etc. Although there are separate payers, there is a lot of standardization in place to prevent fragmentation and therefore an element of complexity.”
“I think there needs to be universal application and standardization. One of the questions is, is it enough here? Is it enough? Will it evolve in the direction we need to go? This creative rejuvenation… “The answer to the question of what the process will look like is what we are currently trying to answer with this project that we are discussing here today,” Emanuel said.
author
See more LDI news
in their own words
Access to healthcare and coverage
Pediatricians say why the child tax credit is actually aimed at improving the health of poor children
Better health brings greater wealth
blog post
Access to healthcare and coverage
Chart of the Day: What's all the fuss about? Private equity acquisitions of physician practices today are much like those of the past.
Penn LDI study provides historical analysis and insight into the future
blog post
health equity
How is the infant development of Black babies affected by incarceration policies?
Study reports link between incarceration policies and birth outcomes
blog post
Healthcare Access and Coverage | Health Equity
Cost and convenience drive PrEP use among transgender people
Research reveals how to shape the future of PreP care
News | Video
Access to healthcare and coverage
Adding diversity to the research process: a new system
Penn team outlines guidelines and best practices
blog post
Healthcare Access and Coverage | Health Equity
Do wealth and poverty affect access to minimally invasive cardiac surgery?
Advanced care is less common in areas with higher levels of poverty, LDI fellows find
