by David C. Pate, M.D., J.D., is president and CEO of St. Luke’s Health System
Superficially, the problem is clear. U.S. healthcare costs are too high, rising too rapidly, and higher than those of other industrialized nations.
And while it may be appealing to blithely conclude that this is the fault of overpaid doctors, overpriced medications, overly expensive new technology, costly hospitals, or greedy insurance companies, those superficial conclusions cause us to miss the mark and offer little in terms of a path to solving the problem. We can and should dig deeper in accounting for the challenges the U.S. faces with the cost of health care.
Numerous studies published in the Journal of the American Medical Association and in Health Affairs have examined the causes of death in the U.S.
What they find is that, rounding for convenience, 40 percent of deaths are related to individual behavior: tobacco use, alcohol use, illicit drug use, obesity, sexually transmitted diseases, suicide, violence, and accidents.
Another 30 percent are due to a genetic predisposition, 20 percent are related to environmental/public health issues, and only 10 percent are related to illnesses and injuries within the purview of our traditional healthcare delivery system.
In comparing U.S. healthcare outcomes with those of other industrialized countries, reports from the Commonwealth Fund, Institute of Medicine, and others have found that Americans die at a younger age than people in almost all other high-income countries.
Americans consume more calories per person, have higher rates of drug abuse, are less likely to use seat belts, are involved in more traffic accidents involving alcohol, and are more likely to use firearms in acts of violence.
Our behaviors mean we have more obesity, injuries, homicides, adolescent pregnancies, sexually transmitted diseases, cases of HIV and AIDS, and drug-related deaths compared with these other countries.
Our healthcare crisis is a complicated, multifactorial problem involving health care inequality, socioeconomic factors, cultural norms, inadequate education, issues involving access to care, and poor health behaviors. And this is why doctors, pharmaceutical companies, device and technology developers, hospitals, and insurance companies will be unable to solve this problem alone.
The traditional focus of health care, treating patients, will never bring healthcare costs under control. And since health care behaviors begin as early as childhood, waiting to treat people until they become patients as a way to control healthcare costs is like trying to put out a forest fire with a fire extinguisher.
All of this is why St. Luke’s is focused on population health management, which entails transforming the business model and the clinical model. Our very smart board members, all of whom live and work in our region, have concluded, as I have, that there is no other way for St. Luke’s to effectively and significantly contribute to the solution that must be implemented to fix these significant challenges.
We invite your interest and engagement. It’s going to take all of us to solve what ails health care in America.