U.S. Health Care Expenditures: Costs, Lessons, and Opportunities Proceedings of a Workshop (2023) / Chapter Skim
Currently Skimming:
2 Economic Perspectives Framing Health Care Expenditure
2 Economic Perspectives Framing Health Care Expenditure
Pages 7-20
The Chapter Skim interface presents what we've algorithmically identified as the most significant single chunk of text within every page in the chapter.
Select key terms on the right to highlight them within pages of the chapter.
From page 7... ...
(McCullough) • Wasteful medical spending results in opportunity costs, i.e., in the loss of potential gain were the money to be spent on social determinants of health or expanded access to care.
|
From page 8... ...
Panelists Mac McCullough, Katherine Baicker, and Monica Bharel then described and discussed trends in health care spending, the opportunity costs associated with health expenditures that result in little to no health benefit, and the question of reallocating some portion of health spending to support other social determinants of health.
|
From page 9... ...
, which is more closely related to spending on the core social determinants of health, the United States ranks second to last among OECD nations.2 The United States spends less on underlying social and physical environments than on clinical care, and not all health care spending has an effect on health outcomes, he added. Health spending that does not improve health is referred to as "wasteful spending," and systems-level research indicates that removing these expenditures from the system would have no negative effects on health, McCullough said (Berwick and Hackbarth, 2012; Fredell et al., 2019; Kelley, 2009; PricewaterhouseCoopers' Health Research Institute, 2008; Shrank et al., 2019)
|
From page 10... ...
The "Health Dividend" of the Opportunity Cost Not only does wasteful spending result in a lack of return on the expense, but the associated opportunity cost also represents the loss of potential gain were the money to be spent in other areas, McCullough explained. Given the estimated $879 billion spent annually on low- or no-value health care, the priorities that could be addressed with this sum are virtually unlimited (Speer et al., 2020)
|
From page 11... ...
McCullough noted that a recent randomized trial found that providing universal income at this level is associated with a host of positive impacts (Kornfield, 2021) .4 Additionally, all public libraries in the United States could be expanded, investment in water infrastructure and clean drinking water could be doubled, and the Supplemental Nutrition Assistance Program (SNAP)
|
From page 12... ...
McCullough noted that a fundamental principle underlying the idea of the health dividend is that the current prioritization of non-value-added services over evidence-based programs carries an opportunity cost. Reprioritizing evidence-based social, qualityof-life, housing, infrastructure, or climate programs may yield a health dividend above and beyond the health outcomes generated by current health care spending.
|
From page 13... ...
to improve the value of the health care delivered, maximizing the health benefit of every dollar spent. Ensuring that every health care dollar is spent on services that produce substantial health improvement does not necessarily mean spending less, Baicker said, but it likely means allocating health care resources differently.
|
From page 14... ...
Non–health care inputs play an important role in health, Baicker noted, but incorporating such inputs into health insurance design requires careful targeting. For example, for some patients health outcomes may improve and health spending go down when healthy food is provided as a way of improving disease management or if air conditioners are provided to avert asthma-driven ED visits.
|
From page 15... ...
MassUP awards state-funded grants to grassroots community innovations intended to achieve food security and economic stability and mobility. For example, a three-way community collaboration among a local medical center, food pantry, and food security council works with food retailers and residents to expand the number of locations offering affordable, healthy food and engages with the community to increase access to existing food benefits and entitlements.
|
From page 16... ...
The following month, the COVID-19 Health Equity Advisory Group convened to understand and address how the social determinants of health create unequal disease burdens between communities. The efforts, Bharel said, included a 2020 statewide community survey to better understand the immediate and long-term health impacts of the pandemic, including access to testing, health care delays, and access to housing, food, safe working conditions, and other factors known to contribute to the COVID-19 bur den.
|
From page 17... ...
The ARP provides incentives to states that have not expanded Medicaid to do so; it also increases ACA health insurance subsidies to extend to more people unable to afford plans offered on the exchange. Baicker added that the ACA brought some experimentation with payment reforms that moved toward paying for quality and outcomes rather than just the quantity of care delivered.
|
From page 18... ...
Baicker replied that telemedicine -- which was underused and not always reimbursed prior to the COVID-19 pandemic -- is an example of a potentially cost-effective method of expanding access to primary care, behavioral and mental health, and specialist services not just in rural areas, but also to underserved urban areas. McCullough remarked that opportunity costs are present in rural settings, so examining the money spent on health and the benefit received from those expenditures remains
|
From page 19... ...
Market Forces in Care Options Given that technology is one of the major drivers of health care costs, Simon asked how technology, innovation, market forces, and competition factor into current health care economics. McCullough shared a personal anecdote from graduate school, in which he noticed that smoking cessation was not included in his student insurance coverage.
|
From page 20... ...
Because public dollars are being spent on health care, McCullough said, the opportunity costs of various routes to producing health outcomes should be considered.
|
Key Terms
This material may be derived from roughly machine-read images, and so is provided only to facilitate research.
More
information on Chapter Skim is available.