159 pages | 1 B/W Illus.
The Paradox: Americans are not as healthy as people in dozens of comparable countries that spend 30 percent less on health care, and our medical marketplace overall is plagued by persistent problems of cost, quality, and access. Yet, the world’s best individual health systems are located in the U.S.—each a unique result of visionary leadership and private initiative, not government-driven health reform.
The Imperatives: Due to powerful new forces explained in this book, medical spending has stopped growing. Purchasers, payers, and patients are no longer willing or able to keep paying more. To stay in business and improve population health, providers and their business partners must eliminate the shameful waste generated by inefficient and ineffective production processes.
The Solution: Simply repairing or repealing the Affordable Care Act will not get us where we want to go. The fundamental roadblock is a wasteful system, not uninsured Americans. Reform needs to be immediately redirected to creating the best health care system that 17 percent of GDP can buy. Money saved by taking the new path to reform can then be used to improve population health through access for all. Paradox and Imperatives in Health Care is the roadmap for getting there.
"This book displays my enduring optimism that visionary leaders who understand the paradox and imperatives are capable of delivering affordable, world-class health services to all Americans. After 45 years in the medical sector, I am an insider who cares deeply about improving our delivery system—a constructive contrarian excited by possibilities for a better future. To start moving us in this new direction, I propose private sector actions for providing care right all the time, as inexpensively as possible."
—Jeffrey C. Bauer, Ph.D., Medical Economist and Health Futurist
Introduction: The Paradox
Analytical Foundation for Solutions
The Target Audience
Note on Authorship
The Economic Challenge: Chaos
End of Growth in Spending: The New Normal
Dramatic Decline in Overall Economic Growth
Increasing Demands from Other Sectors
Constrained Consumer Spending
Increasing Diversification and Competition
Improvement in Scientific Indications for Medical Care
The More Things Change
The Bottom Line: Redirecting Reform
Problems with Predicting the Future of Health Care
Medical Professionalism and Solving Economic Problems
The Economic Imperative: Efficiency (Cost)
Short Run versus Long Run
Tactics versus Strategy
Key to Success: Long-Run Strategy
Need for Common Understanding
Efficiency for Executives
Problems to Avoid
Inefficiency Equals Waste
Enough Waste to Matter?
Policy: One Size Does Not Fit All
What to Do with the Savings?
The Clinical Imperative: Effectiveness (Quality)
Effectiveness: Compliance with Specifications of Performance
Neither Cost nor Value
Why Effectiveness Is an Imperative
Effectiveness and Quality in Health Care
Quality: Consistent, Appropriate, and Safe Care
Redirecting Reform: Performance Standards to Standard Performance
Limitations of Historical Efforts
Effectiveness Comes from Within
Pursuing Efficiency and Effectiveness Together
Setting the Standard for Quality
A Model for the Effectiveness Transformation
Effectiveness for Health Care: Doing It Right
Tools for Efficiency and Effectiveness
Least Common Denominator: Information Technology and Digital Transformation
Data and Analytics
e- and m-Health Technologies
The Performance Improvement Imperative
Expert Consensus: Tools for Changing the Future
Redirecting Reform: Strategic Recommendations
Review of Reasons to Redirect Reform
Policy Recommendation 1: Limit the American Health Sector to 17% of GDP
Policy Recommendation 2: Require Performance Improvement for Federal Reimbursement
Policy Recommendation 3: Develop a National Consensus on a Good Health Care System
Epilogue: Organizational Success Factors for Efficiency and Effectiveness