We often here about the $3.5 trillion we invest annually for Healthcare in the United States. Breaking this down further, this means we spend an average of $10,739 per citizen.
This last number demonstrates how statistics can sometimes be misleading. As noted, we spend an average of $10,739 per citizen. But, understanding where the money is actually going provides a key insight as to why our investments are high but results are often lower than other countries spending less.
Look closely at where the money goes you see that five percent of people account for 50 percent of total health spending.
Think about these stats for a moment.
Health-care spending represents almost one-fifth of the United States’ economy.
In digging further into these numbers, the data from the National Institute for Health Care Management suggests that the health problems of about 15 million Americans consume almost one-tenth of the Gross Domestic Product (GDP) of the United States — around $1.7 trillion.
Those citizens in the “five percent” group are known as “super users” of the health system. They include the “sickest-of-the-sick” or have multiple chronic conditions requiring intense and continuous care regimens.
We are bombarded with stats that show, on average, the United States spends more on health per citizen than any other country on the planet. The reality is that most of these expenditures are concentrated on fewer people entering the health system once they are very ill (including being admitted to expensive, technology rich environments when nearing end-of-life).
Ethicists often ponder the issue of distributive justice…How do we use a finite amount of resources to do the most good for the most people?
To raise the question above is not to suggest we turn our backs on those women and men who are members of the medical “super-users” group whose lives (including quality of life) are dependent on utilizing the system in place today.
If we are serious about true reform, the deeper issue to consider is how we change the systems super-users are dependent on to better serve their needs while becoming more effective stewards of the resources required to meet the needs of this vulnerable population.
As we look ahead, these questions are worth considering by anyone in, or touched by, the current healthcare system.
- What is your view on whether half of all resource expenditures should go towards supporting the needs of a small group of people?
- The rapid growth of the elderly population (a baby-boomer now turns 65 every 15 seconds and will for the next decade) will expand the size of the “super-user” group requiring intensive & costly services. What alternative or innovative ideas would support the needs of this population while making better use of our resources?
- Do you know someone who is a “super user” of the health system? What services are they dependent on? What might you change to better serve his or her needs while make better use of resources?
If you want to go deeper in exploring this topic:
There is a great article in the Atlantic by writers Karen Weintraub and Rachel Zimmerman. Fixing the 5 Percent is a thoughtfully-written piece that explores both the problem as well as solutions others are pioneering to improve the effectiveness of services and costs.
If you want to delve deeper in the actual data and trends download this PDF from the Agengy for Healthcare Quality and Research
National Health Expenditures by type of service and source of funds, CY 1960-2015. CMS. https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/Downloads/NHE2015.zi
“UNDERSTANDING U.S. HEALTH CARE SPENDING”. National Institute of Healthcare Management, July, 2011. http://www.bcnys.org/inside/health/2011/HealthCarePremiumsNIHCM0711.pdf
“The High Concentration of U.S. Health Care Expenditures”. Agency for Healthcare Research and Quality. https://archive.ahrq.gov/research/findings/factsheets/costs/expriach/