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Analysis of U.S. Health Care Indicates Improvement in Outcomes Has Slowed

Despite massive spending, U.S. trails peer nations (November 13)

An examination of health care in the U.S. finds that despite the extraordinary economic success of many of its participants, the health care system has performed relatively poorly by some measures, and that outcomes have improved, but more slowly than in the past and more slowly than in comparable countries, according to an article in the Nov. 13 issue of JAMA.

Using publicly available data, researchers conducted an analysis to identify trends in health care, principally from 1980 to 2011. The areas they addressed included the economics of health care; the profile of people who receive care and of organizations that provide care; and the value created in terms of objective health outcomes and perceptions of quality of care.

Key findings include:

  • In 2011, U.S. health care employed 15.7% of the workforce (21 million people), with expenditures of $2.7 trillion, doubling since 1980 as a percentage of the U.S. gross domestic product (GDP) to 17.9%.
  • Between 2000 and 2010, health care increased faster than any other industry (2.9% per year) but trailed government (3.3% per year); health’s proportion of the GDP doubled between 1980 and 2011.
  • Government funding increased from 31% in 1980 to 42% in 2011.
  • Costs have tripled in real terms over the past two decades. However, the average rate of increase has declined consistently since the mid 1970s and sharply over the last decade.
  • Despite the increases in resources devoted to health care, multiple health metrics, including life expectancy at birth and survival with many diseases, shows the U.S. trailing peer nations.

The researchers write that at the highest level, the U.S. health system is struggling to adapt to competing goals, desires, and expectations. “The conflict among patient desires, physician interests, and social policy is certain to increase. Those tensions will likely become a palpable force that may hinder care integration and inhibit other changes that favor improved outcome and savings. The usual approach is to address each constituency in isolation rather than optimizing efforts across them. The triangle will need to be reconciled. This is the chief challenge of the next decade.”

Sources: JAMA; November 13, 2013; and JAMA Network; November 12, 2013.

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