According the Elizabeth Bradley, a Professor of Health Policy and Administration at Yale, the answer is no. As she and Lauren Taylor point out in a recent New York Times editorial:
We studied 10 years’ worth of data and found that if you counted the combined investment in health care and social services, the United States no longer spent the most money — far from it. In 2005, for example, the United States devoted only 29 percent of gross domestic product to health and social services combined, while countries like Sweden, France, the Netherlands, Belgium and Denmark dedicated 33 percent to 38 percent of their G.D.P. to the combination. We came in 10th.
Bradley and Taylor put forth the argument that the things that make people healthy go beyond what we typically think of as health care. That is, access to employment, good housing, food security, and educational institutions all contribute to population health. I don't think this is a revolutionary thought.
But what is revolutionary is that they authors imply that the answer to our central question for US health care - "Do we get what we pay for?" - might not be the "no" we've always assumed, but a "yes." We just aren't spending enough, at least not on the proximal things that really matter. I don't think that it is that simple - it's hard to know what portion of social service spending actually improves health. But the discourse does need to move in this direction.
Furthermore, another neat aspect of this piece is that Bradley and Taylor's contention doesn't just apply to the macro-level health policy sphere. Imagine a primary care system that takes into account the socioeconomic realities of patients and creates interventions that use these insights to better provide care. A developing country example: subsidizing the transportation fees for HIV/AIDS patients who would otherwise find this to be a barrier and be unable to seek much needed health care. This sort of intervention may be equally important to any medications or lab tests in advancing the health of these patients. I'll talk more about this sort of "economic hotspotting" in a later post.
3 comments:
It does seem like there are huge inefficiencies in the U.S. when it comes to the balance between "health care" vs. "social services" spending. Instead of spending money to combat things like homelessness and poverty, we instead spend lots of money paying for antipsychotic medications and emergency rooms.
Reminds me of this article in the New Yorker about how adverse childhood experiences lead to later problems in overall health. You can get a scan of the full article here if you're interested.
Good call Dan. You are absolutely right. As you know, I'm interested in the long run effects of early childhood health, but I'm also tracking the literature on non-health exposures in childhood and how these persist into adulthood and am always impressed by continues to grow. As you state, its a great illustration to take stock and realize how much of our "non-health" experience actually maps onto health.
Thanks for reading!
Hey Atheen! great blog. GPC curric got me a-wandering the interwebs for more to read and I'm so happy to have stumbled upon Dar He Blogs. Looking forward to catching up and keeping up.
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