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‘The time for incrementalism is over’ – National Academy of Medicine report urges major changes in U.S. health care


Americans spend huge amounts of money for ineffective care, declining life expectancy.

© National Academy of Medicine

© National Academy of Medicine

Radical change is needed to improve America’s failing health system, according to a new analysis published by the National Academy of Medicine (NAM).

The COVID-19 pandemic brought to light a broader American health crisis in which life expectancy has been going down since 2014, said “Valuing America’s Health: Aligning Financing to Reward Better Health and Well-Being,” published this summer by NAM. Compared to other developed nations, the United States is suffering from chronic diseases, a mental health crisis, and rampant opioid overdoses, while spending $4.1 trillion a year on health care.

“Unfortunately, the United States faces a crisis in our collective health and well-being: declining life expectancy driven by long-standing and deepening inequities, a global pandemic, and the persistent inefficiency, ineffectiveness, and high cost of the nation’s health and health care system,” said the preface by J. Michael McGinnis, MD, MPP, NAM’s Leonard D. Schaeffer executive officer, and report steering group Chair Hoangmai Pham, MD, MPH.

They and coauthors called for a new focus on whole person health, “a person’s ability to thrive and attain their full, optimized potential for health and well-being.”

Possible solutions

The committee set goals to reach by 2030 if critical stakeholders start taking action now.

  • Reduce by 50% the public and private expenditures currently spent on health care services and processes that do not improve health. Health care waste estimates vary, but range up to $935 billion for fragmented care, fraud, and excess administrative complexity. Eliminating that could cut health care spending by $200 billion a year, the report said.
  • Increase by 50% the public and private expenditures on social interventions shown to benefit public health. The United States currently trails other developed nations in the ratio of money spent on health and social services.
  • Use population-based global budgets across all payers to ensure at least 50% of the U.S. population has access to a broad range of social interventions necessary to be healthy. Global budgeting provides a fixed amount of money to an accountable entity for services provided to a specified population over time, instead of payment for individual services or cases.
  • Tie 75% of health care provider and plan revenues to performance metrics based on health and well-being outcomes that matter most to patients, families, and communities.
  • Boost community health engagement by showing progress in at least 50 of the 100 counties with the worst health status, defined by years of potential life lost. Examples of whole-person and whole-population health measures could be maternal or infant mortality, suicide rates, employment, educational attainment, or patient-reported outcomes.

The report included suggested action steps for patients, families, and communities; local, state, and federal legislators and policy makers; care delivery organizations and health systems; payers; employers; and the financial sector.

The NAM steering committee used business and government response to climate change as a model for how conditions can change for better across the globe in a relatively short period of time.

“The time for incrementalism is over,” the report said. “Americans must act quickly and collectively to appropriately value our health and change how we conceive of health and well-being going forward and shape the conditions that promote it. The urgency that has propelled change in responding to the climate crisis must now fuel how health and health care leaders consider our nation’s health.”

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