Frequently, we hear the blanket statement that what the United States pays for its healthcare on a per capita basis is much higher than other countries while our outcomes are significantly worse. Making this statement, however, requires us to define what the desired results of our system and its efficiency actually are. Efficiency describes the relation of inputs and outputs. What do we characterize as our output? Is it longevity or quality of life? What are our inputs? Is it purely dollars spent on the delivery of healthcare within a narrow context or is it all social determinants of health?For example, in dissecting this thought, one might proclaim, our poverty rate is 7% higher than that of England. Therefore, one could argue that the cost of health in England has been costlier than stated since their social services to prevent poverty have a price, and consequently, that cost is a portion of their overall healthcare spending. Moreover, the inverse argues that much of our increased spending in comparison is related to our increased poverty levels.
Another interesting input that requires a more in-depth comparison is the cause of death as it relates to social norms and regulations. For example, in the United States, firearms account for 11 deaths per 100,000 and more than twice that of the costly, nonfatal, injuries. How does this compare to other countries? Let me be clear, I am not commenting on gun control, but it is important to consider the factor contributing to death and injuries; what we consider as a right also has an impact on our healthcare efficiency and costs.
Shifting to desired outputs, do we believe longevity is of greater importance than one’s quality of life? If we examine our healthcare outputs, most agree our current focus remains on quality of life. Though our life expectancy is lower than others, our time for receiving care, such as a knee replacement or open-heart surgery for angina treatment leads one to argue that the quality is of more importance than quantity (years lived). Therefore, there is an elevation in our healthcare expenditures in areas that improve access to desired procedures that influence one’s quality of life and not the longevity of their life.
As we debate the value of care delivered and the impact of healthcare costs on our economy, it is essential to answer the question, “What is the problem we are trying to solve?” Is it how do we live longer and create life expectancy equity amongst the members of our society, or is it how do we embrace the time we have and worry less about costs?
My point is not to select a side, only to exemplify the polarity of our conversations.
Without discussions on these root definitions and desires, we will not have an agreement on possible solutions. Currently, we continue to strive to manage these dualities, being a country that both cherishes individual rights, and desires not to leave our fellow human being behind. We should persevere in our endeavors to optimize both dynamics, while also recognizing the potential impact of the information we examine and how it is used to define the degree of how beneficial or harmful it is regarding the state of our healthcare