By Contributing Author, Sharon Hicks
Open Minds, Affiliate Member
Integration in health and human services remains an elusive goal. Which is curious, since it is important to both consumers and payers, for different reasons. The current state of coordination of care for most consumers is far from “coordinated.” [i] In many cases, basics like trying to get records from one health care professional to another or just getting an appointment with a specialist can take herculean efforts. And when you add in integration with all the services that a person/or family system needs, the efforts are tripled. The United States is not a leader in this area. In fact, it lags many other countries.
The reasons are simple.
A review of the spending habits of other countries from the OECD data gives us some insight into the causes and system changes that could be helpful. In fact, most of us would not be surprised to learn that the USA spends a much higher proportion of our economy on healthcare than other major countries. Our spending is about 17% of GDP compared to the major European countries that have spending between 9% and 12%. [ii]
But despite our significant spending, the US has similar or worse outcomes on several key measures of health, such as infant mortality and the prevalence of chronic diseases. One difference that can be measured, and may be causal, is the ratio of spending in America between medical services and social services. Social services are things like housing assistance, food aid, and child support and medical experts are increasingly citing that the inclusion of these types of social determinants of health (SDOH) can result in better long-term health than does intensive and expensive medical care.
From an article from the Brookings Institute:
“The US is very much the outlier on spending devoted to social services compared with medical care. The major (OECD) countries on average spend about $1.70 on social services for each $1 on health services. But the US spends just 56 cents per health dollar. Yet research [iii] shows that basic measures of health in countries are more closely and positively associated with social service spending than with health spending. That’s also true when you look at different states within this country; states with a higher ratio of social to health spending have significantly better health outcomes in many areas, including adult obesity, diabetes, lung cancer, asthma, and heart disease. It’s hard to escape the conclusion that we should gradually be redirecting a lot of money from medical services to the so-called “upstream” factors that are associated with health. Better to spend money on prevention, in other words, than on expensive medical repair shops after the damage has been done.”
The Organization for Economic Cooperation and Development (OECD) is an international intergovernmental entity with 38 member countries. These countries agree to share carefully defined data sets that are associated with various economic indicators. This data sharing allows a platform to compare policy experiences, seek answers to common problems and identify good practices. The data set that is shared around the topic of health and human services spending provides some very interesting insights into how the US compares to its peers. Review of these international data points demonstrate the value of integrated care of health, human, and social services.
These types of comparisons are even more important given the health care system crises [iv] that have been exacerbated (and brought to the forefront) by COVID-19. Workforce shortages, deterioration of working conditions, escalating costs, increased personal expense for patients who are receiving care, quality of care issues, etc.
From an editorial by the CEO of the American Medical Association:
COVID-19 is a crisis because the threat to public health, our economy and our way of life is immediate. But eventually…this nightmare will come to an end. Whenever that day arrives, we’ll be left with the realization that much about our health system is failing the very people it’s supposed to serve—the public. [v]
He cites the following tasks ahead:
- Realigning our health system around the need to prevent and treat chronic disease, which affects some 100 million people in the U.S. and represents more than 80 cents out of every dollar spent on health care.
- Solving the dilemma of data liquidity so that information can more seamlessly be shared across systems.
- Training our physician workforce for the challenges of the 21st century, not the 20th.
- Eliminating needless paperwork and regulatory burdens that are obstacles to efficient, high-quality care.
- Working with purpose to root out racism inside the halls of medicine and to identify and eliminate systemic inequities that are most responsible for poorer health outcomes for Black and Brown communities. [vi]
The work that is ahead of us to move the ratio of health spending to social service spending will be very difficult, but we know that good health technology and integration of care models is a good first step. Effective and secure data-sharing is mission critical to identify and deploy, which could be best used to improve a person’s functioning over the long-term. Interoperability and agreement on common language will help demonstrate which services are most effective in improving health for certain types of people. This can then lead to policy reform that is evidence-based.
As the United States healthcare system begins to embrace integrated care, let us work to ensure that it transcends the integration of behavioral and physical healthcare, and grows to encompass social determinants of health, human services, and basic social services.
As Mr. Butler states in his article “The spending numbers show that we clearly have the will and the money to improve the health care of Americans and to address health inequities. But we have got to realize that improving health and spending money on health (medical) services is not necessarily the same thing.” [vii]
[iv] Lofgren R, Karpf M, Perman J, Higdon CM. Acad Med. 2006 Aug;81(8):713-20