The US healthcare system has become too complex and costly to continue business as usual, with problems that threaten the nation's economic stability and global effectiveness, experts have warned.
These problems - which include inefficiencies, an overwhelming amount of data and other economic and quality barriers - also hinder progress in improving health, they add, in a new report from the Institute of Medicine (IOM).
The costs of the US system's inefficiency underscore the urgent need for a systemwide transformation, say the committee of experts which produced the report. They calculate that about 30% of US health spending in 2009 - around $750 billion - was wasted on unnecessary services, excessive administration costs, fraud and other problems. And inefficiencies cause needless suffering - by one estimate, in 2005 around 75,000 deaths might have been averted if every US state had delivered care at the quality level of the best-performing state.The knowledge and tools to put the health system on the right course to achieve continuous improvement and better quality care at lower cost do exist, but incremental upgrades and changes by individual hospitals or providers will not suffice, they warn.
Instead, there needs to be across-the-board commitment to transform US health care into a “learning” system that “continuously improves by systematically capturing and broadly disseminating lessons from every care experience and new research discovery. It will necessitate embracing new technologies to collect and tap clinical data at the point of care, engaging patients and their families as partners, and establishing greater teamwork and transparency within health care organisations," says the report."Incentives and payment systems should emphasise the value and outcomes of care," it adds.
"The threats to Americans' health and economic security are clear and compelling," said Mark D Smith, president and chief executive of the California HealthCare Foundation, who chaired the committee producing the report."Our healthcare system lags in its ability to adapt, affordably meet patients' needs and consistently achieve better outcomes. But we have the knowhow and technology to make substantial improvement on costs and quality," he added.
The way healthcare providers currently train, practice and learn new information cannot keep pace with the flood of research discoveries and technological advances, the report warns. Also, how healthcare organisations approach the delivery of care and the way providers are paid for their services also often lead to inefficiencies and lower effectiveness, and may hinder improvement, it adds.
The experts call for improved use of data, which they say is a critical element of a continuously improving health system. In the US, about 75 million people have more than one chronic condition, requiring coordinative and multiple specialists and therapies, and this can increase the potential for miscommunication, misdiagnosis, potentially conflicting interventions and dangerous drug interactions, they warn. Moreover, health professionals and patients frequently lack relevant and useful information at the point of care where decisions are made, and it can take years for new breakthroughs to gain widespread adoption; for example, it took 13 years for the use of beta blockers to become standard practice after they were shown to improve survival rates for heart attack victims.Mobile technologies and electronic health records offer significant potential to capture and share health data better, says the report, and it calls on the National Coordinator for Health Information Technology, IT developers and standard-setting organisations to ensure that these systems are "robust and interoperable." Clinicians and care organisations should fully adopt these technologies, and patients should be encouraged to use tools such as personal health information portals, to actively engage in their care, it adds.
US healthcare costs have increased at a greater rate that the national economy as a whole for 31 of the last 40 years, and most payment systems emphasise volume over quality and value by reimbursing providers for individual procedures and tests rather than paying a flat rate or reimbursing based on patient outcomes, the report goes on. It calls on health economists, researchers, professional societies and insurance providers to work together on ways to measure quality performance, and design new payment models and incentives that reward high-value care.
There also needs to be greater participation by patients and their families in care decisions and management of their conditions, and developers of healthcare products should create tools that help people manage their health and communicate with their providers, the experts add.
Finally, they say, increased transparency about the costs and outcomes of care boosts opportunities to learn and improve, and should be a hallmark of institutions’ organisational cultures. Linking providers' performance to patient outcomes and measuring performance against internal and external benchmarks allows organisations to nuance their quality and become better stewards of limited resources, while managers should ensure that their institutions foster teamwork, staff empowerment and open communication, they emphasise.