Going Below The Surface E-newsletter: April 2019
April 24, 2019
April showers bring May flowers, and in that vein, it’s certainly been raining conversations about health care spending. Will those conversations take root and blossom into thoughtful solutions? We hope so!
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One of the challenges to a comprehensive conversation about health spending is that it is too easy to have a narrow definition of costs — or a narrow definition of benefits — that skews how we think about value. This month, two critical pieces ask us to think more broadly to help understand why we spend … and what we receive in return.
When it comes to defining what we seek from life, the World Health Organization’s well-known definition of health — “a state of complete physical, mental, and social well being, and not merely the absence of disease or infirmity” — is only a start. We need to ensure the next level up — the social determinants of health: education, food, transportation. And we need to go even a level beyond that, to flourishing.
The idea of “flourishing” was unpacked in a Journal of the American Medical Association piece this month, offering clinicians a roadmap for discussing with patients not only how they are feeling, but how they are doing in the most profound sense of the word. In many cases, what is valued in the quest for fulfillment goes beyond — or may even be in opposition to — what is valued in health.
Why It Matters: “Flourishing” will differ for every person, and may mean spending less resources on health services and more on other priorities. That idea should be at the center of how patients are treated, but such a perspective also underscores how dangerous one-size-fits-all assessments of value might be. Not only is medical value difficult to define at the societal level, it is even harder to standardize a definition of “flourishing.”
Venture capitalist Robert Kocher highlighted one of the less-recognized aspects of the continued boom in health care spending — the jump in hospital staffing — in a Health Affairs Blog post. Kocher runs the numbers: hospital staff is growing even as hospital bed occupancy is flat over the past 15 years, life expectancy is falling and medical errors remain a leading cause of mortality.
And the growth isn’t in the number of clinicians: it’s support staff, who now outnumber clinicians 3.6 to 1. Kocher’s argument isn’t solely that there is an over-staffing problem, but that we have a productivity problem: administration that doesn’t improve outcomes — a reality that has to change if the health system is to regain control of costs. “Let’s hope that one of the benefits of big technology companies such as Amazon, Google, and Apple entering health care is that they infect the ecosystem with their 10-times better labor productivity,” he concludes.
Why It Matters: Some parts of the health care system are subject to intense scrutiny around costs and cost effectiveness, but Kocher’s article is a reminder that other elements of the system almost entirely escape such examination. Solving the issue of spiraling health costs may mean promoting efforts to find ways to quantify costs that are now often invisible in such assessments.
Recent journal articles are sowing seeds of thought on how to address health care spending on both the macro and micro levels. Check out this month’s picks below:
A little over a year after the launch of Going Below The Surface, the health spending conversation is more important now than ever. We checked in with David Cutler, PhD, Otto Eckstein Professor of Applied Economics at Harvard University (@Cutler_econ), who participated in our kick-off conference with Health Affairs in 2018, for his quick take on the topic and the importance of keeping this conversation going.
“If we are ever going to address the problem of medical spending in the U.S., we need to go below the surface. We know much more about prices — why they differ so much across organizations and countries, and what we could do about that. I am optimistic that the country will be able to make meaningful changes to bend the cost curve. I look forward to contributing to this effort.”
– David Cutler, Otto Eckstein Professor of Applied Economics at Harvard University
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