the United States is projected to spend more than $5 trillion this year on health care. Yet by most measures, from chronic disease burden to the availability of hospital beds, our system performs worse than those in other wealthy nations. Americans can expect to live four years less, on average, than people in those countries.
Peter Hussey has spent his research career trying to slow the runaway costs of American health care while improving its quality. He’s now a vice president at RAND and director of RAND Health Care. He oversees more than 200 researchers working to save lives from opioids, strengthen mental health care, and ensure more people have access to the care they need.
Hussey considered becoming a medical doctor himself. But that disconnect between what Americans pay for health care and what we get pushed him into research instead. “What motivates me now,” he said, “is just a desire to build a health care system as great as the people and the resources we put into it.”
The United States spends far more than any other country on health care. Yet Americans still live shorter, sicker lives than people in most other wealthy countries. If you had to put it on a bumper sticker, how would you explain what’s happening here?
It’s the prices, stupid. That was the title of a paper I published with some colleagues more than 20 years ago, and it still holds up today. We spend much more, but don’t get much more from our system. Take the new weight-loss drug Ozempic. If you look at how much you would pay for one treatment of Ozempic in the United States, it’s multiple times what you would pay in other countries. And the same goes for everything else. Every interaction we have with our health care system is more expensive than in other countries.
Part of it is that we like to have the latest treatments, and those are typically more expensive. Part of it is that other countries are more comfortable having the government play a bigger role in keeping prices down. It’s tempting to think, well, maybe it’s because we’re going to the doctor more, we’re going to the hospital more. But that’s not it. We operate as though we’re willing to spend infinite amounts to be healthier, but there are limits to that, and that leads to the system we have.
Every interaction we have with our health care system is more expensive than in other countries.
What is one change you would make to improve the quality of health care in America?
The biggest improvement would come from better coordination of care. This might sound familiar if you’ve had any recent experiences with the health care system. You walk in, and it can be overwhelming to try to figure out what’s happening and where to go. You have different providers, different specialists, in-network, out-of-network, follow-up visits. And a lot of the time, you’re on your own. There are models out there that help people navigate the system and ensure they’re getting the care they need. We know it’s possible; it’s just very hard work. That’s where I would start.
What about reducing costs? Are there any strategies that haven’t gotten the attention they deserve?
There’s a lot of potential in technology, but we just don’t have the incentives right. In most industries, new technology comes on board, and it makes it a lot easier and cheaper to do things. In health care, new technology often means more expensive ways to do things. For example, there’s a new ultrasound device that can plug into a smartphone. It’s extremely mobile, can be done all over the place. But it’s much easier to extend that into new places, doing new ultrasounds on people, than to replace all the existing ultrasounds with something less expensive.
All throughout our system, there are places where people could unleash their innovation and find ways to do things cheaper. But what we hear from entrepreneurs, over and over again, is that the incentives just aren’t there. They need to demonstrate a business model that will pay off. And in our health care system, that usually means doing more complicated, more expensive things instead.
What’s a recent study from RAND Health Care that you found especially important?
We looked last year at how to help children suffering from diarrheal diseases. This is a really common cause of death throughout the world. The treatment is cheap, it’s extremely effective—and it’s widely underused. Nobody has really been able to understand why.
We hired actors in India to go to providers and pretend to be parents with a sick child. And what we found was that the providers didn’t think parents wanted this very simple treatment, which is called oral rehydration therapy. They thought the parents wanted something stronger, like antibiotics, which usually don’t help. But when we surveyed parents, they were largely open to the rehydration treatment. That disconnect between what providers thought people wanted for their kids, and what they actually did want, was the main barrier. Addressing that will save many, many thousands of young lives.
Looking ahead to the next few years, what developments are you watching as potential game changers in health care?
What I’m most excited about are the breakthroughs we’re seeing right now in biotech, in big data, in AI. They’re enabling major advances in medicine and in how we deliver health care, and the pace of change is only accelerating. The challenge is going to be unlocking the full potential of those developments, making sure the benefits are applied as quickly and as widely as possible. That’s what we’re focused on at RAND.
source: RAND
