By many accounts, the United States’ healthcare system is among the most advanced in the world. We have launched countless innovative technologies, life-changing medical devices and equipment, and our healthcare providers are consistently and successfully treating highly complex and rare diseases. Such innovation comes at a cost, however, and sometimes it’s questionable as to whether or not we are seeing a return on our investment.
The U.S. spends a lot on innovation in healthcare. And we certainly do have many successes to show for it, but we also lag most industrialized nations in numerous access, efficiency, and quality metrics. As President Obama has said, “We spend one and a half times more per person on healthcare than any other country, but we aren’t any healthier for it.”
In 2014, the U.S. spent more than $9,000 per person per year on healthcare. Total healthcare spending accounted for 17.4 percent of the Gross Domestic Product (GDP), which is far more than any other country. Yet, according to the Commonwealth Fund, the U.S. ranks last among 11 industrialized countries on measures of quality, access to care, efficiency, equity, and healthy lives.
A number of factors may contribute to America’s low healthcare ROI. Chief among them is the delivery of care to our nation’s most vulnerable populations. Ineffective management of social determinants has led to weak outcomes and has proven to be a costly endeavor. And yet, it’s an even more expensive problem to ignore. In fact, for social and behavioral health needs to remain untreated has resulted in an additional $85 billion in annual Medicaid spending—a fifth of all Medicaid spending—due to high readmission rates and abuse of emergency care systems.
Other countries that outrank the U.S. in performance and health outcomes have made a direct effort to address social determinants head-on. While U.S. spending on social services and healthcare collectively is comparable to other countries, the U.S. spends significantly less on social services than healthcare. A recent study showed that other industrialized countries spent on average $2 on social services for every $1 of healthcare spending, while the U.S. spent about $0.55 on social services for every dollar spent on healthcare.
Individuals with social determinants—those who lack the basic necessities including food and shelter, battle addiction or mental illness, or face other challenges preventing them from managing their own health—need more coordinated care and community support.
As President and CEO of the Mount Sinai Health System, Dr. Kenneth Davis, wrote in a Health Affairs blog post, “To achieve our goal of better health outcomes, especially for the needy, we must provide a continuum of care, integrating social services with medical treatment to ensure patients remain healthy.”
Numerous studies have supported that bridging the gap between social services and healthcare has improved outcomes and proved to be cost efficient. A review of 19 studies looking at partnerships between social service and healthcare organizations by the Blue Cross Blue Shield of Massachusetts Foundation concluded that vulnerable populations experienced health gains when their care was coordinated throughout the care continuum with primary, specialty, behavioral and social services. They also found when care was coordinated there was an evident reduction in hospitalizations and emergency visits.
The research speaks for itself. By addressing social determinants and providing care earlier and in a more efficient manner, outcomes will improve, costs will decrease, and America will no longer rank last in health outcomes measures. That’s an investment we would all like to see a healthy return on.