Politicization of health care preventing real changes to out-of-control system, researchers suggest

November 12, 2013

Over the last decade, the biggest driver of the high health care costs in the United States has been neither the aging of the population nor the large numbers of tests and treatments being prescribed.

Instead, new Johns Hopkins-led analysis described in the Nov. 13 issue of the Journal of the American Medical Association suggests it has been the increasing prices of drugs, medical devices and hospital costs -- prices that doctors, patients and insurers rarely know until the money has been spent. The administrative costs alone -- the costs associated with physicians and hospitals procuring payment from health insurers and individuals -- are rising by 6 percent a year.

Study leader Hamilton Moses III, M.D., an adjunct professor of neurology at the Johns Hopkins University School of Medicine and former chief physician of The Johns Hopkins Hospital, says the paper outlines the "sobering reality" of the U.S. health care system in 2013 -- one that is on an unsustainable path that needs righting, a task that seems ever bleaker in the current climate.

"Health care has become so politicized that rational discussions based on valid information have become impossible," says Moses, who also runs Alerion, Inc., a Virginia-based consulting group. "But we are living in a time where we spend more money on health care than other developed countries and our outcomes are worse. Yet, we fail to understand the differences or to learn the others' lessons."

Moses is expected to discuss the new research at a press conference at 9:30 a.m. EST on Nov. 12 at the National Press Club in Washington, D.C.

The JAMA analysis, conducted with colleagues at the Boston Consulting Group and the University of Rochester School of Medicine, attempts to dispel several common misconceptions informing the current health care debate. The researchers used publicly available information about who pays for and who supplies medical care.

While the average rate of growth has decreased steadily since the 1970s, Moses says the 18 percent of its gross domestic product (GDP) that the United States spends on health care is 50 to 60 percent higher than any other developed country. Life expectancy, which has been on the rise for a century, is now not growing as quickly in the United States as it is in the rest of the developed world, a shift that began in the 1980s, with the United States lagging by three years in both men and women. Though many policymakers point to the elderly as the biggest consumers of health care, it is actually those younger than 65 with chronic illnesses who account for two-thirds of expenditures.

Moreover, Moses says, patients are further removed than ever from the true cost of health care. Individuals' out-of-pocket costs declined from 23 percent of the cost of their medical care in 1980 to 11 percent of the cost in 2011. Those costs have been shifted to employers and the federal government, whose share grew from 31 percent of costs to 42 percent over those same three decades. All of this despite the fact that the rate of growth in health care costs is not increasing as quickly as it has been.

Moses and his colleagues describe three major forces that will change health and medicine in the decade to come. First is consolidation and industrialization, with a smaller number of much larger insurance companies and hospital systems. "This will result in less choice of where people get care. And they will likely be asked to shift their allegiance to an institution, rather than have a single physician," Moses says. The second is information technology, which holds great promise to coordinate care and improve quality but, despite large investments, has not yet delivered on the promise. Third is the patient acting as an informed consumer, gaining greater influence than today.

"Costs are completely invisible to you and to your doctor," he says. "Unless the prices of services, of drugs, of devices are known, you cannot have any kind of effective market. Moreover, many prices are fixed by the federal government or negotiated with hospitals confidentially, further removing levers that can lower prices."

Moses points out that the United States is also lagging behind the developed world in the proportion of primary care doctors, something that takes its toll not just in preventive medicine but in coordination of care once someone becomes sick. He says this comes through when, say, a person with diabetes or depression requires a joint replacement. These patients are much more likely to suffer complications, but few specialists are on the lookout for them.

"Specialists can attend to one problem, but few can see the totality," he says.

What is needed is an investment in people -- in primary care doctors, in innovations that can streamline the process of care to improve outcomes. He says 4 percent of health care spending has gone to biomedical research into new technology (drugs and devices), while only 0.1 percent has gone to improving the process of care.

"Nearly every other industry has found a way to invest, reduce costs and improve outcomes," he says. The airlines, for example, after deregulation in the '70s, built information systems that allowed them to save on fuel, streamline routes and cut the cost-per-mile in half. Thirty years later, more people fly, consumers pay "rock bottom" prices, safety is far greater -- but flying can now be an unpleasant experience, he says.

Would people tolerate less choice, less freedom in their health care? Moses doubts the airline model is the answer, he says, but a discussion, based on valid and unbiased information, must begin to truly innovate to deliver greater value and lower cost. Thus far, he says, "the political process has failed us badly."

"There is a risk that political squabbling will cause the country to miss a chance to achieve a more effective and efficient way to deliver care -- one that truly reflects patients' needs and their preferences. The current state of health care is unsustainable, and tensions are only growing."
Johns Hopkins Medicine (JHM), headquartered in Baltimore, Maryland, is a $6.7 billion integrated global health enterprise and one of the leading academic health care systems in the United States. JHM unites physicians and scientists of the Johns Hopkins University School of Medicine with the organizations, health professionals and facilities of The Johns Hopkins Hospital and Health System. JHM's vision, "Together, we will deliver the promise of medicine," is supported by its mission to improve the health of the community and the world by setting the standard of excellence in medical education, research and clinical care. Diverse and inclusive, JHM educates medical students, scientists, health care professionals and the public; conducts biomedical research; and provides patient-centered medicine to prevent, diagnose and treat human illness. JHM operates six academic and community hospitals, four suburban health care and surgery centers, and more than 35 Johns Hopkins Community Physicians sites. The Johns Hopkins Hospital, opened in 1889, was ranked number one in the nation for 21 years in a row by U.S. News & World Report. For more information about Johns Hopkins Medicine, its research, education and clinical programs, and for the latest health, science and research news, visit http://www.hopkinsmedicine.org.

Media Contacts: Stephanie Desmon
410-955-8665; sdesmon1@jhmi.edu
Helen Jones
410-502-9422; hjones49@jhmi.edu

Johns Hopkins Medicine

Related Health Care Articles from Brightsurf:

Study evaluates new World Health Organization Labor Care Guide for maternity care providers
The World Health Organization developed the new Labor Care Guide to support clinicians in providing good quality, women-centered care during labor and childbirth.

Six ways primary care "medical homes" are lowering health care spending
New analysis of 394 U.S. primary care practices identifies the aspects of care delivery that are associated with lower health care spending and lower utilization of emergency care and hospital admissions.

Modifiable health risks linked to more than $730 billion in US health care costs
Modifiable health risks, such as obesity, high blood pressure, and smoking, were linked to over $730 billion in health care spending in the US in 2016, according to a study published in The Lancet Public Health.

Spending on primary care vs. other US health care expenditures
National health care survey data were used to assess the amount of money spent on primary care relative to other areas of health care spending in the US from 2002 to 2016.

MU Health Care neurologist publishes guidance related to COVID-19 and stroke care
A University of Missouri Health Care neurologist has published more than 40 new recommendations for evaluating and treating stroke patients based on international research examining the link between stroke and novel coronavirus (COVID-19).

Large federal program aimed at providing better health care underfunds primary care
Despite a mandate to help patients make better-informed health care decisions, a ten-year research program established under the Affordable Care Act has funded a relatively small number of studies that examine primary care, the setting where the majority of patients in the US receive treatment.

International medical graduates care for Medicare patients with greater health care needs
A study by a Massachusetts General Hospital research team indicates that internal medicine physicians who are graduates of medical schools outside the US care for Medicare patients with more complex medical needs than those cared for by graduates of American medical schools.

The Lancet Global Health: Improved access to care not sufficient to improve health, as epidemic of poor quality care revealed
Of the 8.6 million deaths from conditions treatable by health care, poor-quality care is responsible for an estimated 5 million deaths per year -- more than deaths due to insufficient access to care (3.6 million) .

Under Affordable Care Act, Americans have had more preventive care for heart health
By reducing out-of-pocket costs for preventive treatment, the Affordable Care Act appears to have encouraged more people to have health screenings related to their cardiovascular health.

High-deductible health care plans curb both cost and usage, including preventive care
A team of researchers based at IUPUI has conducted the first systematic review of studies examining the relationship between high-deductible health care plans and the use of health care services.

Read More: Health Care News and Health Care Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.