Foreword by Harvey V. Fineberg, President of the Institute of Medicine
For decades, experts have puzzled over why the US spends more on health care but suffers poorer outcomes than other industrialized nations. Now Elizabeth H. Bradley and Lauren A. Taylor marshal extensive research, including a comparative study of health care data from thirty countries, and get to the root of this paradox: We've left out of our tally the most impactful expenditures countries make to improve the health of their populationsinvestments in social services.
In The American Health Care Paradox, Bradley and Taylor illuminate how narrow definitions of “health care,” archaic divisions in the distribution of health and social services, and our allergy to government programs combine to create needless suffering in individual lives, even as health care spending continues to soar. They show us how and why the US health care “system” developed as it did; examine the constraints on, and possibilities for, reform; and profile inspiring new initiatives from around the world.
Offering a unique and clarifying perspective on the problems the Affordable Care Act won't solve, this book also points a new way forward.
|Edition description:||First Trade Paper Edition|
|Product dimensions:||5.40(w) x 8.10(h) x 0.70(d)|
About the Author
Elizabeth H. Bradley is the president of Vassar College, professor of science, technology, and society, and professor of political science. She has been a recipient of a Bill & Melinda Gates Foundation grant, and was previously the founder and faculty director of the Global Health Leadership Institute at Yale University and served as hospital administrator at Massachusetts General Hospital. She is a member of the National Academy of Medicine and lives in Poughkeepsie, New York.
Lauren A. Taylor studies public health and medical ethics at Harvard Divinity School, where she is a presidential scholar. She was formerly a program manager at the Yale Global Health Leadership Institute, where she led a research team in building a model for scaling up public health innovations for the Bill & Melinda Gates Foundation. She completed a masters in public health at Yale University in 2009. She lives in Boston, Massachusetts.
Read an Excerpt
Americans do not like being mediocre in national health outcomes but like even less facing the complex web of social conditions that produce and reinforce those uninspiring health outcomes. In short, Americans pay top dollar for hospitals, physicians, medications, and diagnostic testing but skimp in broad areas that are central to health such as housing, clean water, safe food, education, and other social services. It may even be that Americans spend large sums in health care to compensate for what they do not fund in social careand the tradeoff is not good for the country’s health....
Physicians, many of whom see almost 30 patients per day, are increasingly aware that unmet social needs are essential contributors to worse health for Americans, and that they generate substantial costs within the medical system. In a recent national survey of 1,000 primary care physicians by the Robert Wood Johnson Foundation, eighty-five percent agreed that patients’ unmet social needs lead directly to worse health and that those needs are as important to address as patients’ medical conditions.
Physicians further reported that if they had the power to write prescriptions to address social needs, these prescriptions would represent one of every seven they write. Top social needs were noted as fitness (by 75% of respondents), nutritious food (by 64% of respondents), employment assistance (52% of respondents), education (49% of respondents), and housing (43% of respondents).
Among physicians we interviewed, many expressed frustration that medical tools do not address the most important drivers of poor health. One chief of emergency medicine summarized his work: “We bandage them and send them out, but what they do out there is a black box. Who knows what happens then?”
Table of Contents
C O N T E N T S
A Note on Quotations vii
Foreword by Harvey V. Fineberg ix
CHAPTER 1 THE PARADOX 1
CHAPTER 2 HISTORICAL PERSPECTIVES 21
CHAPTER 3 FRONT-LINE INSIGHTS 49
CHAPTER 4 LEARNING FROM ABROAD 81
CHAPTER 5 HOME-GROWN INNOVATIONS 121
CHAPTER 6 AN AMERICAN WAY FORWARD 151
CHAPTER 7 CONTINUING THE DISCOURSE 181
Appendix A: Interviewees 199
Appendix B: Social Values in Scandinavia and the United States: Similarities and Differences 203
Appendix C: Accountable Care Organization
(ACO) Performance Measures, 2012 209