The American Health Care Paradox PDF Free Download

  1. Medina Healthcare System
  2. The American Health Care Paradox PDF free. download full
  3. The American Health Care Paradox Pdf Free Download Free

S ankofa is an aphorism from the Akan people of Ghana. Derived from the words San (return), Ko (go), and Fa (look, seek, and take), the word and its symbol translate as “It is not taboo to fetch what is at risk of being left behind.”. The Sankofa symbol is a mythical bird shown with its feet and body facing forward, its head. Although the US spending more of its GDP on health care than any other country, it is not a high spender when one sums spending on both health care and social services. However has the lowest ratio of our social service spending to health care spending in the OECD, and countries with lower ratios on average have worse health outcomes.

Medina Healthcare System

  1. Nancy E. Adler ( [email protected] ) is vice chair of the Department of Psychiatry and director of the Center for Health and Community at the University of California, San Francisco.
PUBLISHED:June 2014Free Access

The United States has the unfortunate distinction of having the world’s highest health care expenditures but scoring near the bottom on population health. It ranks twenty-seventh in life expectancy among the thirty-four Organization for Economic Cooperation and Development (OECD) countries and even lower in infant mortality. The fact that the disproportionate US investment in health care has not yielded better population health is well established, but the reasons for it are less clear. Most explanations focus on medical system shortcomings, but these do not fully account for the superior health of those in other countries. In The American Health Care Paradox , Elizabeth Bradley and Lauren Taylor argue that the answer lies in inadequate attention to nonmedical determinants of health.

The book’s central argument is that we spend too much on health care, which is estimated to account for only about 10 percent of premature deaths, while spending too little on the social, behavioral, and environmental factors that account for 60–70 percent of premature deaths. Looking across OECD countries, Bradley and Taylor find that people live longer in countries with the most favorable balance of resources dedicated to improving human welfare relative to resources for medical services. We are in the middle of the pack on total spending for health and human welfare, but we get there through a combination of low per capita spending on social services and high per capita spending on health care. This leaves us, regrettably, with the most adverse ratio of health to social service spending of any OECD country.

This argument may seem arcane, but Bradley and Taylor’s well-written book provides vivid examples of the problems resulting from this imbalance. With almost 18 percent of our gross domestic product going to health care, fewer resources are available for early childhood education, food and housing supports, neighborhood safety, and so forth. In a vicious cycle, this underinvestment fosters adverse social conditions that damage health and increase the demand for and cost of health care. Among more than eighty people interviewed for the book, and whose experiences animate the statistical analysis, an internist reported, “I am sitting here writing a prescription [for] this person who has limited ability to afford the medication or have insight on the situation, who can’t go outside because the neighborhood is unsafe…and I am totally unable to do my job.”

The American Health Care Paradox seems to be written for a general readership—a worthy undertaking, given the intensity of public debate about health care and the degree of misinformation about it. The book contrasts the United States with Scandinavian countries, which are better able “to balance ‘upstream’ work to keep people healthy through adequate services in the social sphere, with ‘downstream’ work of medical care for people after they have become ill.” Anticipating criticism that the Scandinavians are so different from us that there is little to learn, the authors provide extensive, but not wholly convincing, data on the similarity of our values. The book’s concrete examples of how the Scandinavians integrate services are more useful.

The authors’ analysis of previous US efforts to integrate social services with health care is particularly informative. Much can be learned from the successes and failures of the neighborhood health center movement in the mid-1960s and the development of health maintenance organizations in the mid-1970s. After initial success, both were undermined by self-interested opponents and stymied by American values favoring individual responsibility and initiative over collective action. The recent establishment of accountable care organizations may encourage coordination, but Bradley and Taylor observe an already narrowing focus, exemplified by the lack of population health indicators in reimbursement calculations.

Even without political conflicts, the challenge of addressing social as well as health needs is daunting. One could become “paralyzed by the complexity inherent in the relationships among health, social services, and health outcomes, and…consider strategic action all but impossible.” The book provides a counterweight to such pessimism. The authors examine four case studies of successful “home grown innovations” that provide evidence that it is, in fact, feasible to integrate social and medical services. Bradley and Taylor identify common elements of the four organizations while acknowledging that there is no simple formula. Although offering no prescription, they make a compelling case that “changing the dialogue around health to be holistic and inclusive of nonmedical contributions is paramount to resolving the spend more, get less phenomenon in American health care.”

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The American Health Care Paradox PDF free. download full


The American Health Care Paradox Pdf Free Download Free

Project HOPE—The People-to-People Health Foundation, Inc.