When Medicare and Medicaid were enacted in 1965, the gross domestic product (GDP) attributable to health care was just under 6 percent. However, according to Davidson (2013), the United States now spends 17.2 percent ($8,608 per American per year) of GDP on health care. Out of 48 countries ranked, the U.S. landed in second place (behind Switzerland) for dollars spent. On the other hand, health care quality in the U.S. ranked 46 out of 48, just in front of Serbia and Brazil. Although Switzerland pays more per capita for health care than the U.S., Switzerland’s quality ranks in the top 10 (Davidson, 2013). The organization I work for, Novant Health, is not immune to the aforementioned statistics. The problem: The U.S. health care system is costly, highly inefficient and lacks quality compared to other industrialized nations. Why has this decline in the U.S. health care system and thus Novant Health left us towards the bottom of the barrel?
Methodology and Analysis
The Delp-type model systems approach presented at the end of this report (Figure 1, page 6) describes the interrelationship between health care system operations, health behaviors and socioeconomic conditions and the impact each has on Novant Health’s efficiency and quality of care. Included in Figure 1 are the following contributing factors:
• Chronic medical conditions
• Lack of healthy lifestyles
• Fee-for-service system
• Fragmented health care delivery
• Government subsidized insurance coverage (Medicare and Medicaid)
• Uninsured due to lack of affordable health insurance
• Inconsistent use of best medical practices
• Limited access to primary care
• Lack of preventive care
• Overuse of costly medical procedures
These factors can be subdivided into three segments: behavioral conditions, socioeconomic conditions and health care system operations. Each of these will be discussed further.
Behavioral Conditions – In North Carolina (where the majority of Novant Health operates), there is a high prevalence of citizens who lack healthy lifestyles. The following behaviors are proven to be a primary cause of chronic medical conditions: improper nutrition, lack of exercise, smoking, alcohol consumption, and improper drug use (illicit and prescription medications). In addition, there are a high number of North Carolina residents who do not take advantage of preventive care.
Socioeconomic Conditions - According to DeNavas-Walt et al. (2011) the number of impoverished (defined as income less than 100% of the established poverty level) U.S. citizens is estimated to be 46.2 million. Children under the age of 18 account for 16.4 of the 46.2 million. According to the North Carolina Institute of Medicine (2013), there is an estimated range of 15.6 to 22.3 (broken down by county) percent of the North Carolina population who are uninsured. In addition, 15.9% (48.6 million) people in the U.S. are covered by Medicaid and 14.5% (44.3 million) people are covered by Medicare.