WBB's Thought Leadership

Moving U.S. Healthcare from Last to First

August 16

There are four root causes for the U.S. healthcare system to be ranked last among high-income countries and spend more on healthcare than any other country.

Root causes include lack of access, underinvestment in primary care, administrative inefficiency, and disparities in care delivery.

Excerpt: “Many Americans believe that the United States has the best health care system in the world, but surprisingly little evidence supports that belief. On the contrary, since 2004, reports from the Commonwealth Fund have consistently ranked the performance of the U.S. health care system last among high-income countries, despite the fact that we spend far more on health care than these other countries.”

“The first challenge the U.S. health care system must confront is lack of access to health care. The high-income countries that are top-ranked according to the most recent Fund report (the United Kingdom, Australia, and the Netherlands) offer universal insurance coverage with minimal out-of-pocket costs for preventive and primary care. Affordable and comprehensive insurance coverage is fundamental. If people are uninsured, some delay seeking care, some of those end up with serious health problems, and some of them die.”3

“The second challenge is the relative underinvestment in primary care in the United States as compared with other countries. Other countries make primary care widely, and more uniformly, available. In contrast to the United States, a higher percentage of these countries’ professional workforce is dedicated to primary care than to specialty care, and they enable delivery of a wider range of services at first contact, even at night and on weekends.”

“The third challenge is the administrative inefficiency of the U.S. health care system. Both patients and professionals in the United States are baffled by the complexity of obtaining care and paying for it. Clinicians and their staff spend countless hours completing documentation to prove that insurance coverage is active, that benefits and services are covered, that services were delivered, and that payment or reimbursement occurred. [...] if we changed our reimbursement systems to use global payments, fee schedules, formularies, and defined benefits, it would make benefits and costs more predictable for patients and revenue more predictable for clinicians.”

“The fourth challenge is the pervasiveness in the United States of disparities in the delivery of care. Other countries achieve better population health by spending relatively more on social services than on medical care.”5

SourceNew England Journal of Medicine

WBB Take: While underinvestment in Primary Care is a policy issue that can only be solved by readjusting investment and focus, inefficient administration, lack of access, and care disparities are problems that can in part be addressed with Quality Improvement (QI) approaches. Of the $3 Trillion spent per year on healthcare in the U.S., researchers have found that a third is waste, and provides no value to patients. Likewise, much of the administrative cost is due to duplication, lack of workflow efficiency, and poor design. As a result, the administration costs are high, and care is delayed and expensive. A lack of monitoring and evaluation (M&E) of Health IT (HIT) projects, clinical approaches and workflow, and policy implementation results in inefficiencies and poor health outcomes.

Effective M&E, Quality Assurance (QA), and Process Improvement (PI) approaches can reduce waste, increase efficiency, and help to reduce disparities caused by misalignment of policies, resources, and funding.

Cited by Matthew Loxton


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