Monday, January 27, 2014

American Health Care Paradox

I attended an interesting seminar on Friday. It was entitled Mobilizing a Multi-sector Approach to a Healthier America: Resolving the “spend more/achieve less” paradox. It was sponsored by the Connecticut Council for Philanthropy, the Donaghue Foundation and the Connecticut Association of Nonprofits. The main speakers were Dr. Elizabeth Bradley, professor of public health at Yale, faculty director of its Global Health Leadership Institute and author, will share comments about the complicated question "why is our society less healthy than other industrialized countries when the U.S. spends so much more on health care? and co-author, Lauren Taylor, MPH., Dr. Bradley offered insights from extensive research and discussed how our current health care system provides limited outcomes while expending excessive resources. They are the authors of a new book "The American Health Care Paradox." 

The authors began by showing us that the US spends more per capita in health care costs than any other member of the Organization for Economic Co-operation and Development (a group of 34 industrialized countries), and achieves dismal outcomes. They shared statistics which demonstrated that America ranks very low among the 34 industrialized countries, ranking 25th in maternal mortality, 26th in life expectancy, 28th in low birth weight, and 31st in infant mortality, for example. 

However, the picture becomes more interesting when you add the spending that these countries do per capita on social support. That includes such things as food stamps, housing help, early infant care, every other type of social welfare. When the two types of spending are added together, the US spends an average amount, in the middle of the per capita spending. The US spends a very large percentage of the total on health care, where as other countries spend a larger percentage of the total on social support. In the US, for $1 spent on health care, about $0.55 is spent on social services. In the OECD on average, for $1 spent on health care, about $2.00 is spent on social services. In other words, we spend more of our social help dollar on healing illness; other countries spend more on supporting better living conditions for the population. The authors did extensive analysis that proved that with or without including the US in the mix, the higher the percentage spent on social support, the better the health outcomes. 

In other words- when you spend more of your total health and quality of life dollar on social services, you get better outcomes. 

The authors described an interesting difference in values that contributes to the decision making around allocation of money. One area of difference that stood out to me was our sense of who social supports are for. We would all agree in America that we all use health care. But in America we think that social supports are for the “other”: the poor, the minority, those who are different from us. In other countries, such as the Scandinavian countries, supports are considered to be necessary for all. In America, if you have a baby, you get an in home visitor if you meet certain risk criteria. In European countries, every new mother with a baby gets in home visitation. 

Bradley and Taylor described some programs which have combined social service and medical spending to achieve notably good results (let me know if you want the citations). They and other speakers promoted that the Affordable Health Care Act offered opportunities for such programs. 

I felt that their argument is greatly bolstered by the ACEs study. The ACEs study is proof that social conditions leading to child abuse and maltreatment cost our society many millions in health care costs. Once again, our money would be spent more effectively by addressing social stressors which lead to child abuse and maltreatment than it is presently by treating the resultant severe medical disorders. 

I won a copy of the book so I will post again after I read it. Please click on comment to share your thoughts on this important topic.





Sunday, January 19, 2014

To the End of June

Happy New Year!

I would like to start the year by recommending a book: To the End of June by Cris Beam (Houghton Mifflin Harcourt 2013). This is a book about the foster care system, told both through carefully researched facts and information and through the stories of the children and families who make up the system. Amazon describes it as: “Who are the children of foster care? What, as a country, do we owe them? Cris Beam, a foster mother herself, spent five years immersed in the world of foster care, looking into these questions and tracing firsthand stories. The result is To the End of June, an unforgettable portrait that takes us deep inside the lives of foster children at the critical points in their search for a stable, loving family. Focusing intensely on a few foster families who are deeply invested in the system’s success, To the End of June is essential for humanizing and challenging a broken system, while at the same time it is a tribute to resiliency and offers hope for real change.”

It is hard to use ones’ free time to read a book about work that is this intense. However, this book demonstrates in a deep way how the behavior of our kids makes complete sense given their experience. And it also shows how the trauma histories of the birth parents results in the children entering foster care. The deep tie between parents and children, no matter how much pain and disappointment there has been, is explored.

The book shows clearly how every child needs a permanent connection, no matter how old they are. One story focuses on a family who adopts older, aging out youth, and provides them with the support they need for the transition to adulthood.

Another aspect that becomes clear is how ultra-sensitive our kids are to even the faintest whiff of potential rejection, and how they immediately withdraw and reject the parent as soon as they conclude that rejection is coming. Rejection feels like the most likely outcome to them, and they don’t want to stick around to experience it.

The book also contains a lot of information that would be helpful in funding applications, as it clearly documents the connection between failed foster care and other expensive societal problems such as homelessness and crime.

I highly recommend this book.