Skyrocketing healthcare spending is having far-reaching consequences on the American economy. It contributes to keeping wages stagnant, and crowds out opportunities for consumers to spend on other types of social care that would otherwise improve their health.
The social and economic environment in America needs to provide better access to education, incentives towards healthier lifestyles, and access to economically viable and accessible healthcare. I argue here that our national spending is misguided, or at the very least, is due for redirection – a slow righting of the ship, as it were, if we want a healthier population.
Technology and innovation have already started to make the shift and are paving the way to reset what we expect from our societies. Government funding must now refocus energy and funds towards the social determinants of health if we intend to reform what we are seeing today. Leaders looking to make an impact must pause to consider their social responsibility to evolve society, demanding the government’s attention and investing in the programs that will bring about change in the social foundation.
So let’s look at the numbers. Data shows that more than 44% of healthcare spending in the US is on treatments of the 15 top chronic conditions, a percentage that continues to rise. These increases are due less to increasing costs of procedures and treatment for these conditions, and more attributable to the growing population that requires treatment. This means that either the population as a whole is becoming unhealthier, and/or more people have access to tests that confirm their condition. Either way, spending will increase, and downplaying the importance of the social causes of our health issues will continue to weaken our society both physically and economically.
The average US citizen shells out $1300 a year on healthcare. Compared to $250 spent in 1980, that’s a 420% jump to where we are now. Americans are projected to increase spending by $40 to $50 per capita going forward, making the aggregated out-of-pocket expenditure $609 billion in 2019! Despite not having a universal healthcare system, US spending on healthcare is one of the highest in the world and caused by our lack of focus on the social issues that drive health. These staggering numbers beg us to pause and re-assess our predicament.
The best place to begin the shift from a reactive to proactive approach to human health is with social care.
Social care refers to societal influences on an individual’s development, and resolving the issues with social care has the power to create a healthy population over a single generation.
So what exactly are these social determinants of health? In a very compelling discussion on “Social Health IT and How Digital Tech Can Boost the Social Determinants of Health” at HIMSS17 in Orlando this year, health economist Jane Sarasohn-Kahn urged the healthcare IT industry to pay more attention to the technologies that can move the foundation of social care forward. She summarized social determinants as follows:
Other wealthy countries prioritize the social care needs of their population that influence lifestyle and health. The resulting reduced healthcare spending is evidence of it being a better approach. Specifically, in 2013 the US spent 17% of GDP on healthcare while spending only 9% of GDP on social care. Countries like France and the Netherlands spend in reverse, with 20-25% of GDP spending on social care and less than half that on healthcare. The result is a healthier population, more accessible healthcare options, higher life expectancy, lower infant mortality, fewer people with chronic conditions, and lower obesity rates. The out-of-pocket expenditure per capita in France and the Netherlands is about one-fourth that of the United States, at $250-$270, leaving more money in the pockets of people to invest in things that influence social well-being and health. Instead of tackling symptoms on the defensive, the United States must fix what is broken in the social determinants of health in order to get ahead of the game.
The Health IT industry is working hard to address the issues of accessibility by resolving the high costs of delivery and availability with smarter platforms. Telemedicine, support networks, nursing care and coaching, and evolving forms of doctor-patient interaction are all addressing this fundamental social need, allowing providers to spend their time providing clinical care rather than spending it in research and documentation. This ultimately improves the quality of care, while telemedicine and alternate forms of doctor-patient interaction make healthcare more readily available than ever before.
In fact, world-wide IT entrepreneurship is already having a positive impact in underprivileged communities. Access to healthier food options, healthcare providers, and medicine is beginning to surface through innovation and social responsibility.
Take for example the SNAP program, where Amazon has partnered with the USDA on food stamps. The Amazon platform provides a facility to deliver fresh foods to homes that are on food stamp programs, allowing families in food deserts to gain access to more nutritious choices. Embedded within this program are approaches to behavioral economics, where a $10 food stamp is valued at $20 for healthier choices, nudging people towards a particular action and behavior change (but that’s a blog for another day).
Disruptive and socially-conscious companies like AirJaldi in India are partnering with large organizations like Microsoft to deliver reliable broadband access to rural and remote parts of India. These kinds of initiatives are fundamental to improving the health of the country. Doctors visits through telemedicine and prescription ordering/delivery through online platforms immediately opens up large communities of poor to accessible healthcare. Similar programs are emerging across America as well. Cool & Connected, for instance, is a pilot program sponsored by the USDA’s Rural Utilities Service and the U.S. Environmental Protection Agency Office of Sustainable Communities that helps rural communities develop strategies for broadband service to promote smart and sustainable development.
New healthcare models have emerged that reward providers, and even corporations, based on their patient or employee health outcomes. Companies like Envolve PeopleCare provide incentives towards lower health insurance premiums if a company’s employees enroll and participate in non-clinical health improvement programs, like smoking cessation or weight loss. Creating that kind of accountability could drive more investment into social care and in the long run balance out US spending.
Ultimately, however, technology initiatives could end up a mere drop in the bucket if the more fundamental social care issues (like childhood education) are not addressed alongside them. Left unreformed, America’s healthcare industry will remain reactive, and we will fall more than a few steps behind economically