U.S. Health Care Expenditures
Costs, Lessons, and Opportunities
PROCEEDINGS OF A WORKSHOP
Anna Nicholson and Tamara Haag, Rapporteurs
Roundtable on Population Health Improvement
Board on Population Health and Public Health Practice
Health and Medicine Division
THE NATIONAL ACADEMIES PRESS
Washington, DC
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This activity was supported by contracts between the National Academy of Sciences and Aetna Foundation, Kresge Foundation, New York Health Foundation, Robert Wood Johnson Foundation, and additional support from the Association from American Medical Colleges, Blue Cross Blue Shield of North Carolina, Fannie Rippel Foundation, Nemours, Samueli Foundation, and Wake Forest Baptist Health. Any opinions, findings, conclusions, or recommendations expressed in this publication do not necessarily reflect the views of any organization or agency that provided support for the project.
International Standard Book Number-13: 978-0-309-27515-6
International Standard Book Number-10: 0-309-27515-6
Digital Object Identifier: https://doi.org/10.17226/26425
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Suggested citation: National Academies of Sciences, Engineering, and Medicine. 2023. U.S. health care expenditures: Costs, lessons, and opportunities: Proceedings of a workshop. Washington, DC: The National Academies Press. https://doi.org/10.17226/26425.
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PLANNING COMMITTEE ON U.S. HEALTH CARE EXPENDITURES: COSTS, LESSONS, AND OPPORTUNITIES1
SANNE MAGNAN (Chair), Senior Fellow, HealthPartners Institute, Emerald Isle, NC
RACHEL BLOCK, Program Officer, Milbank Memorial Fund, New York, NY
ADAM BRESS, Associate Professor of Population Health Sciences, Division of Health System Innovation and Research, University of Utah School of Medicine, Salt Lake City
DORA HUGHES, Associate Research Professor, The George Washington University, Washington, DC
MARC GOUREVITCH, Chair and Muriel G. and George W. Singer Professor of Population Health, Department of Population Health; Professor, Department of Medicine; Professor, Department of Psychiatry, NYU Grossman School of Medicine and NYU Langone Health, New York, NY
MEG GUERIN-CALVERT, Senior Managing Director and President, Center for Healthcare Economics and Policy; Economic Consultant, FTI Consulting, Washington, DC
ERIC SCHNEIDER, Senior Vice President for Policy and Research, The Commonwealth Fund, New York, NY
KOSALI SIMON, O’Neill School of Public and Environmental Affairs, Class of 1948 Herman Wells Professor, Associate Vice Provost for Health Sciences, Indiana University, Bloomington
LAUREN TAYLOR, Postdoctoral Fellow, Department of Population Health, NYU Grossman School of Medicine, New York, NY
__________________
1 The National Academies of Sciences, Engineering, and Medicine’s planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteur and the institution.
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ROUNDTABLE ON POPULATION HEALTH IMPROVEMENT1
RAYMOND BAXTER (Co-chair), Trustee, Blue Shield of California Foundation, San Francisco, CA
KIRSTEN BIBBINS-DOMINGO (Co-chair), Professor and Chair of the Department of Epidemiology and Biostatistics; Lee Goldman, M.D., Endowed Professor of Medicine; Vice Dean for Population Health and Health Equity, University of California, San Francisco, School of Medicine
PHILIP M. ALBERTI, Senior Director, Health Equity Research and Policy, Association of American Medical Colleges, Washington, DC
DAWN ALLEY, Chief Strategy Officer, Center for Medicare & Medicaid Innovation, Washington, DC
JOHN AUERBACH, Executive Director, Trust for America’s Health, Washington, DC
CATHY BAASE, Chair, Board of Directors, Michigan Health Improvement Alliance; Consultant for Health Strategy, Dow Chemical Company, Saginaw, MI
DEBBIE I. CHANG, President and Chief Executive Officer, Blue Shield of California Foundation, San Francisco, CA
ALLISON GERTEL-ROSENBERG, Operational Vice President, National Policy and Practice, Nemours, Washington, DC
MARC N. GOUREVITCH, Professor and Chair, Department of Population Health, NYU Grossman School of Medicine and NYU Langone Health, New York, NY
GARTH GRAHAM, President, Aetna Foundation, Hartford, CT
MEG GUERIN-CALVERT, Senior Managing Director and President, Center for Healthcare, Economics and Policy, FTI Consulting, Washington, DC
GARY R. GUNDERSON, Vice President, Faith Health, School of Divinity, Wake Forest University, Winston-Salem, NC
DORA HUGHES, Associate Research Professor of Health Policy and Management, Milken Institute School of Public Health, The George Washington University, Washington, DC
SHERI JOHNSON, Director, Population Health Institute; Associate Professor, Department of Population Health Sciences, School of Medicine and Public Health, University of Wisconsin–Madison
___________________
1 The National Academies of Sciences, Engineering, and Medicines planning committees are solely responsible for organizing the workshop, identifying topics, and choosing speakers. The responsibility for the published Proceedings of a Workshop rests with the workshop rapporteurs and the institution.
WAYNE JONAS, Executive Director, Integrative Health Programs, H & S Ventures, Samueli Foundation, Alexandria, VA
ROBERT M. KAPLAN, Professor, Center for Advanced Study in the Behavioral Sciences, Stanford University, Stanford, CA
MICHELLE LARKIN, Associate Vice President, Associate Chief of Staff, Robert Wood Johnson Foundation, Princeton, NJ
MILTON LITTLE, President, United Way of Greater Atlanta, Atlanta, GA
PHYLLIS D. MEADOWS, Senior Fellow, Health Program, Kresge Foundation, Troy, MI
BOBBY MILSTEIN, Director, ReThink Health, Morristown, NJ
JOSÉ T. MONTERO, Director, Center for State, Tribal, Local and Territorial Support; Deputy Director, Centers for Disease Control and Prevention, Atlanta, GA
VON NGUYEN, Senior Vice President and Chief Medical Officer, Blue Cross Blue Shield of North Carolina, Durham, NC
WILLIE OGLESBY, Interim Dean, College of Population Health, Jefferson University, Philadelphia, PA
JASON PURNELL, Vice President, Community Health Improvement, BJC HealthCare; Associate Professor, Brown School, Washington University in St. Louis, St. Louis, MO
LOURDES J. RODRÍGUEZ, Senior Program Officer, St. David’s Foundation, Austin, TX
PAMELA RUSSO, Senior Program Officer, Robert Wood Johnson Foundation, Princeton, NJ
KOSALI SIMON, Herman B. Wells Endowed Professor, Associate Vice Provost for Health Sciences, Paul H. O’Neill School of Public and Environmental Affairs, Indiana University, Bloomington
HANH CAO YU, Chief Learning Officer, The California Endowment, Oakland, CA
Health and Medicine Division Staff
CARLA ALVARADO, Program Officer (through January 2021)
MAGGIE ANDERSON, Research Assistant (beginning September 2021)
ALINA BACIU, Roundtable Director
AYSHIA COLETRANE, Senior Program Assistant
HARIKA DYER, Research Assistant (through July 2021)
ROSE M. MARTINEZ, Senior Board Director
Reviewers
This Proceedings of a Workshop was reviewed in draft form by individuals chosen for their diverse perspectives and technical expertise. The purpose of this independent review is to provide candid and critical comments that will assist the National Academies of Sciences, Engineering, and Medicine in making each published proceedings as sound as possible and to ensure that it meets the institutional standards for quality, objectivity, evidence, and responsiveness to the charge. The review comments and draft manuscript remain confidential to protect the integrity of the process.
We thank the following individuals for their review of this proceedings:
SHIRLEY GIROUARD, SUNY Downstate Health Sciences University
JOANN YÁNEZ, Association of Accredited Naturopathic Medical Colleges
Although the reviewers listed above provided many constructive comments and suggestions, they were not asked to endorse the content of the proceedings nor did they see the final draft before its release. The review of this proceedings was overseen by MARTIN J. SEPULVEDA, Claraluz LLC. He was responsible for making certain that an independent examination of this proceedings was carried out in accordance with standards of the National Academies and that all review comments were carefully considered. Responsibility for the final content rests entirely with the rapporteur and the National Academies.
We also thank staff member Constance F. Citro for reading and providing helpful comments on this manuscript.
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Contents
Organization of the Proceedings
2 ECONOMIC PERSPECTIVES FRAMING HEALTH CARE EXPENDITURES
A Health Dividend for America: U.S. Health Care Expenditures and Opportunity Costs
Expanding Health Access While Decreasing Wasteful Health Spending
3 INNOVATION TO BEND THE SPENDING CURVE
A State Roadmap to Developing Health Care Cost Growth Benchmarks
Case Example: Delaware’s Journey Toward Health and Quality Benchmarks
4 FRAMING AND SHIFTING THE HEALTH NARRATIVE IN THE UNITED STATES
Perspectives on Health Care Challenges
Shifting an Individualistic Mindset
The Potential Impact of COVID-19 and the Racial Equity Movement on Health Policy
Role of Community-Level Efforts in Policy Change
Perspectives of Medicare Recipients
Techniques Used in Framing Health Spending Reform
Acronyms and Abbreviations
| ACA | Affordable Care Act |
| ACO | accountable care organization |
| AHC | accountable health communities |
| ARP | American Rescue Plan |
| CAPGI | Collaborative Approach to Public Goods Investment |
| CDC | Centers for Disease Control and Prevention |
| CBO | Congressional Budget Office |
| CHART | Community Health Access and Rural Transformation |
| CMMI | Center for Medicare & Medicaid Innovation |
| CMS | Centers for Medicare & Medicaid Services |
| COVID-19 | coronavirus disease 2019 |
| DHSS | Department of Health and Social Services |
| ED | emergency department |
| Geo | Geographic Direct Contracting |
| GDP | gross domestic product |
| HUD | U.S. Department of Housing and Urban Development |
| HCE | health care expenditure |
| HIPAA | Health Insurance Portability and Accountability Act |
| IOM | Institute of Medicine |
| Mass DPH | Massachusetts Department of Public Health |
| MassUP | Moving Massachusetts Upstream |
| MMF | Milbank Memorial Fund |
| MRI | magnetic resonance imaging |
| OECD | Organisation for Economic Co-operation and Development |
| ROI | return on investment |
| SNAP | Supplemental Nutrition Assistance Program |
| TCF | The Commonwealth Fund |
| USofCare | United States of Care |
| UWGC | United Way of Greater Cleveland |
In Memoriam
David K. Jones
1981–2021
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