« The Patient Experience | Main

The Future of US Healthcare


by Barry Bittman, MD

It’s not surprising that every hospital and health institution in America is facing a substantial degree of uncertainty concerning the future of our nation’s healthcare. 

While the writing on the wall certainly includes Accountable Care Organizations, Bundled Payments, Insurance Exchanges, Core Measures, HCAHPS, Meaningful Use and Value-based Purchasing, the precise nature of that which will ultimately shape and enable our healthcare system to survive is at best, uncertain.  

The real question is how can we improve and sustain our  healthcare for future generations? Highly politicized, the Affordable Care Act is poorly understood and widely debated. Yet what appears to be universally agreed upon is a series of remarkably straightforward goals referred to as the Triple Aim: improving the health of populations, improving the experience of care, and reducing per capita healthcare costs.

The pressure is building.  Undoubtedly, something has to give.  

According to the Centers for Medicare and Medicaid, National Health Expenditures grew to $2.5 trillion in 2009, actually more than $8,000 per person, or 17.6% of our Gross Domestic Product. CMS suggests National Healthcare Expenditures will balloon to $4.48 trillion in 2019 or 19.3% of GDP. As a reference point, contrast this with our total actual federal spending in 2009 equal to $3.5 trillion yielding a resultant budget deficit of $1.5 trillion.

Bottom line – we’re no longer running on vapors – the tank is empty and we’re out of funds.  Beyond any reasonable doubt, our deficit situation cannot persist despite all political bantering over healthcare reform or debt ceilings.   And while some have challenged the WHO’s ranking of the US in 37th place among the world’s health systems just behind Dominica and Costa Rica, it’s a fact that healthcare spending as a percentage of GDP distinguishes the US as the world leader.  So does our ranking as number one in the world for cheese production (and not surprisingly, obesity) compared with a shamefully incomprehensible ranking of 47th in infant survival.

Compound our challenge with more  than 50 million uninsured Americans and an additional 25% underinsured, and the nature of the ugly beast that’s rearing its head becomes apparent.

And if you believe that our present challenges are great, just consider that there are more than 40 million Americans age 65 and over in the US and a projected 80 million seniors in 2040.

While these staggering numbers could keep a building full of actuaries arguing for a year, it’s not surprising that most hospitals fear Medicare, Medicaid and commercial insurance payment cuts.  

Neither political party is prepared to openly duel over the matter, yet somehow most healthcare executives believe the ax is about to fall and funding cuts are going to decapitate the highly vulnerable organism we refer to as our ill-fated American healthcare system.

And while that fear is not unjustifiable, the real question is whether or not our present challenges can be solved with a purely economic solution.

Frankly I do not think so. I also don’t  have a crystal ball to foretell the future.

Yet I am convinced that each hospital and healthcare system in America can better prepare itself for weathering the storm regardless of the wind’s direction.  And we must not rely on a federal mandate to do so.

Rather than fretting about future cuts or policy changes, waiting for the sky to fall or contemplating early retirement, we must now work together diligently toward the Triple Aim. You might be surprised to learn how we can effectively reshape what we already have – a broken system supported by the largest per capita healthcare spending in the world.

The real question is where do we begin? 

The answer is a new vision - our rapidly expanding fee-for-service system must give way to focusing on prevention, eliminating wasted services and procedures and reducing costly admissions. There’s never been a better time to break down the healthcare silos and barriers that impede communication and coordination across disciplines.  This predictably results in devastating care gaps. 

A new standard must be set to ensure that doctors, hospitals and third party payers work together cohesively for the well-being of the community.  We must voluntarily and proactively develop and adopt an unprecedented level of coordination between physicians and caregivers, hospital departments, community providers, and healthcare institutions across town and across the nation.  

Sharing of medical records, information, evidence-based solutions and best practices must take precedence over competing at practically any cost. Fragmentation must give way to a reliable continuum of care within a comprehensive patient-centric community care network without walls that replaces the building once affectionately referred to as the hospital.  Patients and families within this network must be encouraged to take an active and meaningful role in healthcare decision-making and end-of-life care.

And when we finally focus on the fact that a mere 5% of our population utilizes 49% of our healthcare resources, the prospect for developing an exemplary high quality sustainable US healthcare system suddenly becomes clearer.  An interdisciplinary healthcare approach orchestrated in a caring, coordinated manner is doable and achievable, within our grasp and ultimately within our budget.

Through evidence-based interdisciplinary prevention strategies and true care coordination with an emphasis on improving outcomes along with the overall patient experience, as a nation we will not only survive… we will thrive as the best healthcare system in the world.

Reader Comments

There are no comments for this journal entry. To create a new comment, use the form below.
Editor Permission Required
You must have editing permission for this entry in order to post comments.