The American Health Care Paradox: Why Spending More is Getting Us Less

In her book Thinking in Systems,22 Professor Meadows highlights the need to locate accountability in a complex adaptive system so as to optimize outcomes. In the United States’ health care sector, putting Meadows’s teaching into practice would mean identifying ways by which actors (for instance, hospitals) feel the impact of their actions on other

In examining broad health interventions, however, recognizing the impact of these larger factors is critical. What might be dismissed as a factor to control in a biomedical experiment, such as the presence of a family support system, is often a fundamental facet of the intervention from a complex systems perspective. As Garrett Hardin, ecologist an

In both cases, providers and patients are working toward their own self-interest given the health care choices they face. Health care providers are trying to make the best living possible by structuring days to see a maximum number of patients, in light of the demands that administrative and paperwork place on their time. Patients and their familie

The increased health care costs for people who are obese compared with those who are not is between $3,000 and $5,000 per year.45 Extrapolated to the state, obesity is associated with an average of an additional $4.2 billion in health care costs per year that is attributable to Mississippi’s obesity epidemic.

The phenomenon has been noted in economics as Roemer’s law of demand,38 in which the supply of medical services generates demand for these medical services. Study after study has demonstrated that, for insured populations, “a hospital bed built is a hospital bed filled.”

One approach might be to establish ACO payment based on performance indicators that measured health and progress on social determinants of health. Examples may include the percent of an ACO’s population that is at a healthy body weight, is not depressed, is employed, is housed, or is on track to graduate from high school or college. Measures would

The limits placed on the practical scope of the ACOs’ mandate echoes the narratives of neighborhood health centers and HMOs, both of which started with a broader view of health and devolved to focus on medical care over time.

This widespread tendency to rely on medicine for health solutions has been termed “medicalization,” which Professor Paula Lantz at the George Washington School of Public Health has succinctly defined as the mistaking of health care for health.

The research literature largely suggests that HMOs succeeded in reducing health expenditures, primarily by reducing health care utilization. The impact on quality is less clear.