In a recent note, I reported that the cost of healthcare in the U.S. was beginning to decline, perhaps due, in part, to reasons other than the drop in the economy (see: Decrease in Healthcare Costs May Persist as Economy Revives). A reader of Lab Soft News submitted the following comment in response to the post:
Costs are down, but has health taken a beating? If people are seeing less of their physicians are they then showing up sicker? Does this give us a healthier population?
I have come to believe that spending more on healthcare does not necessarily result in greater health for a population. The U.S. ranks 40th in life expectancy when compared to other countries according to a 2012 WHO study (see: List of countries by life expectancy). We also spend far more per capita and as a percentage of the GDP on healthcare than all other countries (see: List of countries by total health expenditure (PPP) per capita). I understand that are are other factors at play here such as the homogeneity of populations. Moreover, much of our per capita expenditures for healthcare also come in the form of end-of-life care which is expensive and doesn't always have a positive outcome for the patient (see: The Cost of End-of-Life Care). Here's a quote from the final section of this article:
Near the end of life, clinical priorities change and measures of care should be adjusted accordingly. When illness becomes irreversible, clinical deterioration may no longer justify escalation of care, so risk-adjusted cost analysis may become less relevant than better definition and proper attribution of overaggressive end-of-life care. To avoid desperate overtreatment, better implementation of palliative care is needed, and hospital investment in such services appears fruitful.
A substantial portion of our cost-of-care is related to chronic conditions which could be ameliorated by having patients taking more ownership of their health and introducing more preventive health measures (see: The Need for a Preventive Medicine Infrastructure in the U.S.). The Affordable Care Act (ACA; Obamacare) does earmark some funds for preventive medicine so we can hopefully look forward to some improvements in this aspect of healthcare (see: Preventive Care and the Affordable Care Act). This will require a substantial change in direction of providers away from disease and toward wellness.
The conclusion that can be drawn from all of this is that spending more on healthcare does not necessarily result in better health. Stated a another way, we can reduce our healthcare costs without having health "taking a beating."
Thanks for responding to my comment on your post. As follow-up, I agree that we spend way too much on end of life care, but that won't be reduced without a cultural shift. People expect miracles from medicine based on what they hear on the news and see in TV dramas. We could spend less and get better results, but people have to first start accepting that modern healthcare has limitations, not the least of which is funding. The new push for genomic healthcare is a good example of unrealistic ideas being pushed for profit. If everyone thinks that they are going to get personalized gene targeted healthcare they are dreaming! I know I'm a curmudgeon in this regard, but we first need to have good basic healthcare before we get cadillac genomics, etc. We in for-profit medicine must share the blame for pushing "new and improved" medicine that is unaffordable and only (marginally)benefits the few people who can afford it. I recently heard of a family that wants some genomic test done on their child with cancer. The test looks at sequence variation in multiple genes and provides a "report" of very limited utility since most of the variations have no specific treatment. The test costs about $25000 and is not covered by insurance (why would they when it has limited utility?). The family can afford to pay for this so it's being done with the encouragement of the oncologist. There are others who peddle proteomics reports to desperate patients. Enough said. This is the road to ruin.
Posted by: Ajit Alles | May 14, 2013 at 12:23 PM