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How can we slow growth of U.S. health-care spending?

It’s well-established that the United States needs to reduce its level of health spending, but the $1 million question (or, more accurately, the $2.6 trillion question) is how. As Stanford’s Arnold Milstein, MD, MBA, and UC-Berkeley’s Stephen Shortell, PhD, MBA, argue in a Journal of the American Medical Association perspective piece published today, “the most immediate progress” is likely to come from better caring for the sickest of patients. They write:

Opportunities include preventing expensive health crises among medically fragile patients, helping patients in late stages of serious illness avoid dying in a hospital, increasing patient flow through hospitals to lower average fixed cost per hospitalization, and reducing hospital readmissions.

Milstein directs Stanford’s Clinical Excellence Research Center, which develops innovative models of health care delivery that lower per-capital health spending and improve quality. In the editorial, he and Shortell, dean of Berkeley’s School of Public Health, go on to offer specifics for each approach, including helping very sick patients be more involved in the decision-making process of how and where they spend their last days. (Columnist Bill Keller explored this very issue in yesterday's New York Times.) The authors go on to say:

Medicare spends 25% of its budget on the 5% of beneficiaries who die during a given year. Increasing evidence suggests that palliative care programs are improving the quality of life and lowering the costs of care for patients in late stages of serious illnesses. These programs rely on interdisciplinary teams for patient assessment, helping patients better anticipate their experience of both aggressive and conservative care and respecting patient and family goals of care across a range of nonhospital settings such as home, hospice, and nursing facility.

The two authors also emphasize the importance of slowing the rate of growth of health spending, warning that not doing so could lead to “shifting of funding away from resources for elementary and high school education, infrastructure (such as highways), and basic science research, as well as weakening the global competitiveness and financial health of US workers and their employers.”

Previously: Stanford physician discusses rapid growth of palliative medicine and legislation to meet demands, HHS offers $1B for health care innovations – What would MacGyver do?, When it comes to health-care spending, U.S. is “on a different planet”, New Stanford center to address inefficient health care delivery and Is $618,616 too much to (try to) save a life?
Photo by 401(K) 2012

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