Why Spending More is Getting Us Less
September 23, 2013
Bradley, faculty director of Yale University’s Global Health Leadership Institute, and Taylor, the institute’s former program manager, contrast American healthcare models with the much more successful models in Denmark, Norway, and Sweden. The Scandinavian model, a dramatically more holistic approach envisioning citizen health as inextricably linked to national welfare, views greater spending on housing, education, employment, and nutrition as necessary components of healthcare outcomes, resulting in less overall spending with far greater results. The authors assemble an expansive study of representatives from the health-care and social sectors, including hospital administrators, social workers, physicians, police, emergency service personnel, nurses, educators, and pharmacists to demonstrate the need for integration between medicine and social welfare in the U.S. The disconnect between social services and health care, and the deeper historical schism between public and private interests, emerges as the reason why the U.S., which ranks first in healthcare spending, is mired in disappointing health outcomes. Admirably presented as an apolitical examination of an urgent situation, Bradley and Taylor’s carefully researched and lucidly reported findings, including innovative approaches in Connecticut, Oregon, and California, offer what appears to be an easily rendered fix, but their equally striking depiction of uniquely American hostility to government involvement in private matters, exposes a daunting uphill battle.
October 1, 2013
Bradley (Public Health/Yale Univ.) and Harvard presidential scholar Taylor examine why Americans are less healthy than others around the world, even though the United States spends more on health. The authors show that comparisons between health expenditures and outcomes are misleading since they count different things. The U.S. for example, outspends other advanced sector countries in gross national product terms, but measures of life expectancy, infant mortality and maternal survival are worse. Deconstructing numbers and interviewing professionals has led Bradley and Taylor to conclude that social welfare expenditures ought to be included with health care numbers to bring about a more realistic ranking. The United States is currently in the middle of the pack. To emphasize their point, the authors compare the social welfare spending of the U.S. to that in Scandinavian countries. For example, they demonstrate that helping a diabetic with $50 for new shoes can help to avoid the expenditure of $30,000 for the surgery that follows a visit to the emergency room. They insist that medical costs increase due to a lack of attention to the prevention and early treatment of many easily managed conditions, and they point to the public health benefits of programs for child support, income maintenance, and housing and employment support. The authors pair their comparison with a historical review of U.S. health care policy, showing how the present hospital-dominated arrangements developed out of compromises over repeated efforts to implement health programs. They also review the opposition to public health from the American Medical Association since the New Deal. Accused of advocating for poverty programs, Bradley and Taylor insist that their objective is to improve the effectiveness of spending by broadening access. An important attempt to shift the discussion on health in the United States.
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October 1, 2013
Public-health experts Bradley and Taylor argue that, despite numerous and widespread efforts to rein in health-care costs, America is still paying more and getting less when the overall health of the country is contrasted with those of its international peers, even accounting for differences in national policy. The authors' iteration of the fundamental cause of the system's root paradoxit rewards a person who waits until they're so sick they require expensive care while at the same time shaming the expensive-care provider for, well, charging for the expensive careis not new. What is new here is their call for a holistic approach, integrating social and medical services into a cohesive cross-disciplinary system with the goal of supporting good health. Health-care systems fail because they don't address the life circumstances (education, housing, employment) required to sustain wellness. To be clear, the authors don't endorse a nanny state that becomes all things to all people but, rather, a government that is a catalyst for holistic innovation, nurturing good health at all socioeconomic levels.(Reprinted with permission of Booklist, copyright 2013, American Library Association.)
Starred review from December 1, 2013
Bradley (public health, Yale Univ.) and Taylor (former program manager, Yale Global Health Leadership Inst.) take a fresh look at the reasons why Americans pay more for health care and yet are not as healthy as residents of other industrialized nations, specifically Scandinavian countries. The authors interviewed more than 80 health policy specialists and consumers to help formulate their theories. A key factor is the amount of money other countries spend on social services, treating not just a patient's physical needs but the whole person. The authors consider many factors, such as the necessity for professional collaboration, beliefs in the causes of illness, views on self-reliance, the Scandinavian emphasis on the collective--rather than the individual--good, and the role of government in a democracy. They offer encouragement to programs that have improved the health of individuals in selected American neighborhoods and suggest ways to expand these programs. The Affordable Care Act, aka Obamacare, focuses mainly on providing health care to those previously uninsured, but the authors state that it will most likely not address the root cause of the paradox. While there are many contemporary titles about health care, there is little information available in book format about this specific conundrum. Chapter notes are also included, from professional journals, books, and governmental websites. VERDICT This remarkably well-written, lucid work is highly appropriate for public and academic libraries.--Martha Stone, Treadwell Lib., Boston
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