US Health Policy—2020 and Beyond

Abstract

Health care is always on the minds of the public, usually ranking among the top 3 concerns. Virtually all of the Democratic presidential candidates have discussed or will shortly detail health care proposals, whereas President Trump and the current administration recently expressed support for repealing the Affordable Care Act. With the presidential election just 18 months away, it is an opportune time to introduce a new health policy series in JAMA.While various proposals to improve US health care will certainly differ in content, they will all by necessity share a common theme-a focus on reducing health care costs. In 2017, US health care spending reached $3.5 trillion, and such costs now consume approximately 18% of the gross domestic product (GDP). 1 Even though there has been a slight slowing in the annual growth of health care expenditures, 2 a recent projection suggested that by 2027, health care will consume 22% of the GDP, 3 outpacing the annual rate of inflation and increases in GDP over the next 5 years. This is an unsustainable trajectory.At the same time, there are also crises of access and equity. Recent estimates suggest that nearly 14% of US residents are uninsured, and these numbers are markedly higher among people living in poverty compared with those who are wealthier, as well as among racial and ethnic minority populations compared with white populations. According to the 2017 National Healthcare Quality and Disparities Report, an estimated 40% of adults reported lacking a usual source of care, of which 15% indicated a financial or insurance reason for lacking regular access; these figures are also higher among impoverished persons and individuals of racial or ethnic minority. 4 Quality, though improving overall, remains inequitable as well: substantial differences across a range of quality domains persist for black and Hispanic individuals compared with white individuals.The key question for policy makers is whether there are achievable health policies that will reduce the annual increase in health care expenditures yet at the same time increase access to care (fewer uninsured or underinsured), improve quality, and reduce inequities. Feasible policies likely must also maintain choice, which the majority of people repeatedly maintain is important to them.To set the stage for a constructive policy debate, the first step requires defining the current starting point in coverage and spending (Table). For its population of 325 million in 2017, the United States spent $3.5 trillion on health care. Private health insurance covered approximately 197 million individuals and

Association Between Hospital Market Concentration and Costs of Laryngectomy

“…In 2017, the United States spent $3.5 trillion on health care, accounting for 18% of the gross domestic product . By 2027, health care spending is expected to consume 22% of the gross domestic product, with its growth outpacing the rate of inflation . Hospital prices have increased faster than physician prices, and the price of hospital-based inpatient care has grown more quickly than the price of outpatient care .…”

“…1 By 2027, health care spending is expected to consume 22% of the gross domestic product, with its growth outpacing the rate of inflation. 2 Hospital prices have increased faster than physician prices, and the price of hospital-based inpatient care has grown more quickly than the price of outpatient care. 3 Hospitals accounted for 35% of health care costs in 2017, making hospital care a major target of health care reform efforts aimed at reducing costs through revenue reductions and implementing value-based payment reform models.…”

Bed Allocation Optimization Based on Survival Analysis, Treatment Trajectory and Costs Estimations

“…These managerial insights can, in fact, improve expenditure to eliminate waste and improve medical care quality. Indeed, higher operational efficiency of the hospital has been demonstrated to help control the cost of medical services and, as a result, provide more affordable care and improved access to the public, not to mention high quality care [10]- [12].There is very extensive evidence for the importance of patientcentered care in the decision-making process to use medical resources more efficiently [13]. There are many other problems being encountered both by hospitals and patients.…”