The United States spends more than any other developed country on health care, yet it ranks 25th in maternal mortality and 26th in life expectancy.
Countries that take a broader view of health, meanwhile, and spend liberally on social services pay as much as the United States overall, but have much better health outcomes, Elizabeth H. Bradley said in a keynote speech at the Yale Healthcare Conference last week.
The world’s leaders in strong health outcomes and reasonable spending—Sweden, Norway and Denmark—allocate more of their total health spending on social services including education, housing, employment support, nutrition, and environmental improvements. Citizens in these countries also demonstrate fundamentally different values, according to the World Value Survey, including high levels of trust in both people and government and a belief that government should foster income equality and social mobility.
Bradley further attributed successful health outcomes in the Scandinavian countries to transparent planning and budgeting at the county level. That allows communities to address their biggest problems in targeted, integrated ways.
Bradley, professor in the Department of Health Policy and Management at the Yale School of Public Health and director of the Yale Global Health Initiative and Global Health Leadership Institute. is the co-author of The American Healthcare Paradox: Why Spending More is Getting Us Less, published recently by Public Affairs Books.
“I believe [the Affordable Care Act] really is a new platform with incentives for innovation to promote health,” Bradley said at the conference, held at New Haven’s Omni Hotel. Citing the original vision for neighborhood health centers in the 1960s, Bradley believes that political forces moved them away from their roots as “hinges” between health care and social services that can address fundamental barriers to health such as housing, nutrition and education. “Neighborhood clinics were not conceived as just health care for people who were poor. That shifted through politics and lobbying by the American Medical Association and some federal policymakers, who did not want neighborhood health centers to serve the middle class.”
Asked whether better results were achievable in a multiple payer system, Bradley responded, “I don’t think we need single payer, but a commitment to include everybody. The key ingredient is local involvement.”
Bradley was also awarded the John D. Thompson Distinguished Visiting Fellow Award at the conference. Howard Forman, Yale professor of diagnostic radiology, economics, management and public health, cited Bradley’s evolutionary career as being representative of Thompson’s values. The award pays tribute to the late professor’s contributions as an educator, researcher and mentor in health administration, including his pioneering work in health care finance and quality of care. He was best known, perhaps, for helping to develop the diagnosis related groups for hospital reimbursement.
The annual conference is organized by students at the Yale School of Management and the health professional schools at Yale and brings together hundreds of professionals, scholars and students to discuss current health care issues.