Systems Strategies for Health Throughout the Life Course

• Published in: JAMA : the journal of the American Medical Association 2016-10, Vol.316 (16), p.1639-1640
• Main Authors: McGinnis, J. Michael, Diaz, Angela, Halfon, Neal
• Format: Article
• Language: English
• Subjects: Community Participation; Health - standards; Health care; Health care expenditures; Humans; Information Dissemination; Preventive Health Services - economics; Public health; Quality of care; Quality of Health Care - classification; Quality of Health Care - economics; Quality of Health Care - standards; Quality of Life; Reimbursement Mechanisms; Risk Factors; Social Determinants of Health - economics; Social Determinants of Health - standards; Socioeconomic Factors; United States
• ISSN: 0098-7484; 1538-3598
• DOI: 10.1001/jama.2016.14896

Based on measures of cost, quality, efficiency and equity, the US health system is substantially underperforming--a failure unlikely to respond to incremental modifications in the prevailing system. Rather, the improvements required demand a transformative re-orientation and restructuring, moving beyond the focus on reactive, isolated, and episodic medical care events to an integrated system capable of delivering better health for all. Such systems-focused strategies will be essential in designing and integrating individual and population health goals, treatment- and prevention-oriented interventions, data and learning systems, and payment and governance. At approximately $3 trillion, 2015 US health expenditures account for nearly 18% of the US economy, a level that is highest in the world and about 50% more than the next highest spending country. Yet the US health system ranks only 37th in performance among 191 nations. More telling is that the US has the poorest health of the rich nations, a distinction marked by failing health grades that begin in childhood. Although the US continues to lead the world in producing important health research and technologic advancement, the nation is unable to turn those advances into health gains measured in better population health. Here, McGinnis et al examine why the US is performing so poorly relative to both potential and size of investment.