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

What we fear in the Norwegian health care system is a development where you care for chronic problems by hospitalizing patients. The idea [in Norway] is to try to manage people in local communities, outside hospitals.

A second barrier to coordination between health care services and social services is that different professional cultures, driven by distinct mission statements and models of care, prevail in each sector.

For Americans, the rationing scheme works not through wait times but through the mechanism of price.

the recognition that the health status of a population depends on much more than health care.

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.”

For instance, people from more socioeconomically disadvantaged backgrounds are twice as likely as those from advantaged backgrounds to face serious illness and premature death.40 Among middle-class office workers, those occupying a lower rank in the organizational hierarchy face more disease and earlier death than do higher ranking staff.41 Poverty

This sum of spending is what might be called the national investment in health.

“All people are of equal worth and the individual should be free to act . . . all people should have an equal chance to realize their efforts. For this to be possible, it is necessary that the major differences between the health of different groups should be reduced. The Committee has chosen not to define what health means. Health is a subjective

to balance “upstream” work to keep people healthy through adequate services in the social sphere, with “downstream” work of medical care for people after they have become ill.