Vital Directions for Health and Health Care A National Conversation The Need for Vital Directions in US Health and Health Care Mark B. McClellan, M.D., Ph.D. September 26, 2016
Reduction in overall U.S. mortality “Americans are becoming healthier, living longer, and losing fewer years of life to preventable disease” ( Jin, JAMA, 2016) Source: Jin J. Death in the United States: Changes From 1969 to 2013. JAMA. 2016;315(3):318. doi:10.1001/jama.2015.17432.
Many opportunities for accelerated innovation in health care technology • CRISPR, mitochondrial DNA transfer • Early, more accurate diagnostics using gene sequencing, advanced imaging, and computational processing • Immunotherapies and targeted combination therapies for cancers • Advanced medical devices with minimally-invasive surgery • Cell therapies and regenerative medicine • Fecal microbiota transplant • Ebola vaccine, progress toward Zika vaccine • New antibiotics for resistant organisms • Mobile health monitoring and care • Highly effective precision and predictive medicine
Reduction in the uninsured rate Source: Obama B. United States Health Care Reform: Progress to Date and Next Steps. JAMA. 2016;316(5):525-532. doi:10.1001/jama.2016.9797.
Progress limited by costs, inefficiencies, disparities • US spends ~18% of its GDP on health care, yet trails peer nations in terms of: • Population health outcomes and indicators • Access • Efficiency • Equity
Excess costs and care misalignment • Care decisions and treatment too often are inconsistent with patients’ goals and preferences, or are unnecessary • Total excess costs approaching $750B (IOM, 2013) Image source: Kliff S. We spend $750 billion on unnecessary health care. Two charts explain why. Washington Post . September 7, 2012. https://www.washingtonpost.com/news/wonk/wp/2012/09/07/we- spend-750-billion-on-unnecessary-health-care-two-charts-explain-why/.
Widespread examples of inefficient disease prevention, management, and treatment • Chronic disease rising, treatment inefficient • In 2012, ~50% of US adults had 1+ chronic health conditions; ~25% had 2+ chronic health conditions (CDC) • In 2010, 86% of health care spending was for individuals with 1+ chronic conditions (CDC) • Mental disorders often overlooked and poorly managed • Each year, ~1 in 5 adults experiences a mental disorder (NIMH, 2015) • Serious mental illness costs the US $193B in lost earnings per year (Insel, 2008)
Healthcare and Federal Budget 25 20 Everything else Percent of GDP 15 Healthcare 10 Programs 5 Social Security 0 1974 1984 1994 2004 2014 2024 2034 Fiscal Year Source: McClellan and Saunders, 2016, based on Congressional Budget Office, 2016 Long-Term Budget Outlook.
Tighter budgets and inefficiencies in science and innovation • Resolving the health challenges we face requires investment in strong science, technology, and innovation • Concerning trends: • Falling US share of global investment in biomedical R&D (57% to 44% from 2004-2011, Moses et al., 2015) • Continued barriers in data interoperability, aggregation, and sharing • Rising development costs and uncertain payment for drug, medical technologies, and diagnostics • Gaps in biomedical research workforce training, recruitment, and retention
Comparable total health and social services expenditures to peer nations – but different mix Source: Bradley, EH, Taylor, LA. The American health care paradox: Why spending more is getting us less . 2013
Source: Heiman, HJ, Artiga, S. Beyond Health Care: The Role of Social Determinants in Promoting Health and Health Equity . The Henry J. Kaiser Family Foundation. November 4, 2015.
Income-related disparities in health status • Income-related disparities in mortality risk and life expectancy are rising nationally • Life expectancy rises with income Source: Chetty R, Stepner M, Abraham S, et al. The Association Between Income and Life Expectancy in the United States, 2001-2014. JAMA. 2016;315(16):1750-1766. doi:10.1001/jama.2016.4226.
Persisting disparities in life expectancy gains Source: Chetty R, Stepner M, Abraham S, et al. The Association Between Income and Life Expectancy in the United States, 2001- 2014. JAMA. 2016;315(16):1750-1766. doi:10.1001/jama.2016.4226.
Unfulfilled opportunities for better health, higher- value care, and stronger science and innovation • • Big data to better evidence Prevention by addressing • Better diagnostics social determinants • • Precision medicine m-Health • • New delivery and financing Democratization of health models
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