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The American Health Care Paradox: Why Spending More is Getting Us Less 1 Slide 2 Outline Unraveling the paradox Recurrent themes from service US providers and users Learning from abroad Homegrown innovations here in the US 2 Slide 3 The Paradox 3 THEN THERES THE PROBLEM OF RISING COST. WE SPEND ONE AND A HALF TIMES MORE PER PERSON ON HEALTH CARE THAN ANY OTHER COUNTRY, BUT WE ARENT ANY HEALTHIER FOR IT. - JOINT SESSION OF CONGRESS ON HEALTH 9/9/09 Slide 4 High Spending on Health Care 4 Per capita data downloaded from OECD.StatExtracts. Available at stats.oecd.org Slide 5 US Poor Ranking among 34 OECD Countries 5 Source: OECD, Health at a Glance 2009: OECD Publishing Slide 6 6 What could help explain this paradox? Slide 7 Incorporating Social Service Spending 7 Slide 8 In OECD, for $1 spent on health care, about $2.00 is spent on social services In the US, for $1 spent on health care, about $0.55 is spent on social services 8 Slide 9 Methods and Findings Using OECD pooled data from 1995-2007 on 29 countries, multivariable regression with 5 health outcomes The ratio of social to health spending was significantly associated with better health outcomes: - Less infant mortality, low birth weight, premature death; longer life expectancy - Non-significant for maternal mortality This remained true even when the US was excluded from the analysis 9 Bradley et al., BMJ Qual and Safety 2011 Slide 10 Why do we do it this way? Health care and social service sectors grew up fairly independent from one another Social services, in contrast, were conceived of the poor or aged and the target of charity Health care grew professionalized and fit into a marketable, valued commodity for purchase 10 Slide 11 Recurrent Themes from Provider Interviews 1. Frontline personnel are stretched to respond to the concerns of service users with limited resources. 2. A more holistic approach was desired by both health care and social service providers. 3. Difficulties in establishing relationships between social services and health care have many roots. 11 Slide 12 Frontline Personnel Stretched I am sitting here writing a prescription [for] this person who has limited ability to afford the medication or have insight on the situation, who cant go outside because the neighborhood is unsafeand I am totally unable to do my job. -Internist 12 We have a client who was hospitalized three times in 72 hours because they didnt take the time to really look at what the problem was. They sent her home at midnight. The next morning before seven, an ambulance come to get her again. -Social Worker Slide 13 More Holistic Approach is Desired What we do is an all treaters call -- everyone who is involved with the person, we will sit down at the table and discuss the person, what is the best care that we can give them.We can get three or four agencies working simultaneously side by side for one person; the key is communication and cooperation because if you dont cooperate, it doesnt get you anywhere. - Case manager 13 Slide 14 Many Barriers to Holistic Care -Lack of resources -Differences in cultural and professional norms -Technological and data limitations Even if you got past the privacy issues, it is very hard to tie in all of the information that was useful for the hospital based provider, the outpatient based provider, and social services to be able to capture what an individual is thinking or feeling at a given point in time, to know what intervention is necessary. -Social worker 14 Slide 15 User submitted comment The National Memo this thesis is starting to be accepted. You can see it in the models being rolled out in NY State Rebalancing what we spend on medical care and social services can potentially deliver better health outcomes at lower cost. Cracking this code is a challenge that should concern us all. Huffington Post Slide 16 Experience in Other High-income Countries 16 Slide 17 Conception of Health Your health means everything. - Winthrop University Hospital People should know that health is not the goal of life. But health is definitely a means that you can use to choose exactly the life you want because if you dont have health, then your possibilities cannot flow and grow. -Danish Health and Medicines Authority Executive 17 Slide 18 Joint Planning and Budgeting It is a closed system where 80 percent of the decisions, even those they are decentralized, are made within the public integrated system. Soif one departmentgoes beyond its budget, somebody else will have to be below it. - Denmark, senior health policy analyst 18 Slide 19 Comparisons in Values (Scandinavia versus U.S.) 19 Differences (P