Information Technology Reference
In-Depth Information
Chapter 1
Healthcare Delivery in the US
The United States has a uniquely complex and expensive healthcare system. We are
alone among the industrialized countries in not having a “single payer” or at least a
single entity responsible for making the rules. As a result, each individual health
provider
3
may have to deal with dozens of different health plans, each tailored by
the patient's employer to try to manage rising health costs. This complexity adds
significantly to administrative costs which are estimated at 25-30% of spending.
One study suggests that US healthcare administrative costs at 31% are proportion-
ately nearly twice those in Canada. [
1
] Many studies show that we spend around
twice as much on healthcare as compared to our peer nations. Yet we get relatively
poor results, particularly for routine public health issues and for managing chronic
diseases, the problems that affect most people and drive most healthcare costs. It is
beyond the scope of this topic to examine the merits of the various proposed solu-
tions to these problems but the belief that it can help with them is the core rationale
for federal funding of the deployment of health informatics.
The Chronic Disease Problem
Most Americans think of healthcare in terms of dramatic, high-technology, life-
saving interventions. It's what they see on television; it's what they hear about when
a friend, neighbor, relative or celebrity develops cancer or some other serious condi-
tion. Arguably, the US has the best system for providing that sort of care, as shown
in Fig.
1.1
. Patients here needing what Intermountain Health's Dr. Brent James, a
national thought leader in health quality improvement, calls “rescue care” have a
better chance of survival than in other advanced industrialized nations.
3
I have generally used the more inclusive term “provider” in preference to “physician”. Provider
includes physicians and other professionals such as dentists, nurses and nurse practitioners and,
increasingly, care coordinators. The major exception is cases where I feel a system is quite
specifically designed for use by physicians.
