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Population Health: the Problem to be Solved

By Dr. David C. Pate, News and Community
April 7, 2015

Editor's note: This is the first part of an eight-part series that previously appeared in an abridged form in Becker’s Hospital Review.

Superficially, the problem is clear.

U.S. healthcare costs are too high, higher than that of other industrialized nations, and rising too rapidly.

And while jumping to the assumption that this is the fault of insurance companies, doctors, hospitals, the pharmaceutical companies, or the technology behind all of it may be appealing, finding fault at a superficial level causes us to miss the mark and offers little in terms of a path to solving the problem.

We only need to apply lean thinking and the "5 whys" behind the root-cause analysis methodology we commonly use in hospitals to understand how deficient these superficial explanations are in accounting for the challenges the U.S. faces with healthcare costs.

Numerous studies published in the Journal of the American Medical Association and in Health Affairs have examined the causes of death in the U.S. What they find is that, rounding for convenience, 40 percent of deaths are related to individual behavior: tobacco use, alcohol use, illicit drug use, obesity, sexually transmitted diseases, suicide, violence, and accidents.

Another 30 percent are due to a genetic predisposition, 20 percent are related to environmental/public health issues and only 10 percent are related to illnesses and injuries within the purview of our traditional healthcare delivery system.

In comparing U.S. healthcare outcomes with those of other industrialized countries, reports from the Commonwealth Fund, Institute of Medicine and others have found that Americans die at a younger age than people in almost all other high-income countries.

Americans consume more calories per person, have higher rates of drug abuse, are less likely to use seat belts, are involved in more traffic accidents involving alcohol and are more likely to use firearms in acts of violence than the citizens of other industrialized nations.

Our behaviors mean we have more obesity, injuries, homicides, adolescent pregnancies, sexually transmitted diseases, cases of HIV and AIDS and drug-related deaths compared with these other countries.

Our healthcare crisis is a complicated, multifactorial problem involving healthcare inequality, socioeconomic factors, cultural norms, inadequate education, issues involving access to care and poor health behaviors. And this is why doctors, pharmaceutical companies, device and technology developers, hospitals and insurance companies will be unable to solve this problem alone.

It is also the reason that Congress' approach to controlling healthcare spending by making continuous cuts in reimbursements to hospitals and physicians is not going to address the problem, and arguably makes it worse, especially if the traditional U.S. healthcare delivery system accounts for only 10 percent of the total costs.

The traditional focus of healthcare, treating patients, will never bring healthcare costs under control. And since healthcare behaviors begin as early as childhood, waiting to treat people until they become patients as a way to control healthcare costs is like trying to put out a forest fire with a fire extinguisher.

This, then, is the backdrop to the emergent discussion of population health management. And when we dive a bit deeper into that 10 percent of total healthcare costs, we can begin to understand where we as healthcare providers must focus our efforts to contribute to any possible reduction in U.S. healthcare spending. Next, I’ll dive into the cost problem, and then get into solutions.

About The Author

David C. Pate, M.D., J.D., previously served as president and CEO of St. Luke's Health System, based in Boise, Idaho. Dr. Pate joined the System in 2009 and retired in 2020. He received his medical degree from Baylor College of Medicine in Houston and his law degree from the University of Houston Law Center.