U.S. Health Care: Improving Value
In 2016, the U.S. spent over 3.3 trillion dollars on health care, which represents $10,348 per person and 17.9% of U.S. gross domestic product (GDP). The Congressional Budget Office estimates that by 2040, one out of every three dollars will be spent on health care. Solving the U.S. health care cost crisis will require identifying and eliminating low to no value services, thereby increasing the value per dollar invested in health care. While a variety of pilots and reforms intended to increase value are underway, insights and wisdom from frontline physicians are needed to help drive the design, adoption, and implementation of policies with the best chances of succeeding.
Physician Thinking and Leadership: Addressing a Missed Opportunity
All too often, physicians are left reacting to reforms rather than actively engaged in driving them. To that end, the RAND Health Care Value Survey is an effort to capture physician perceptions and beliefs regarding health care value. The first wave of the survey focuses on two domains of value: the efficiency with which physicians use their time and the appropriateness of care they provide. The survey also engages physicians on why they think low value care happens and asks them to identify the policy options they think have the greatest chances of succeeding. In doing so, the hope is that physician thinking can directly inform and drive the creation and implementation of the most effective policies for improving value.
Methods used to develop this survey and results from its dissemination among a sample of over 1,000 physicians practicing within the Southern California Permanente Medical Group are forthcoming in an August 2018 article in The Permanente Journal titled, “Understanding Waste in Health Care: Perceptions of Frontline Physicians Regarding Time Use and Appropriateness of Care They and Others Provide.” Preliminary results were previously shared at the AcademyHealth 2014 Annual Research Meeting in San Diego, California from June 8-10, 2014 in a podium presentation titled, A Survey of Physician Perceptions on Improving Health Care Value, by J. Caloyeras, M. Kanter, N. Cowell, C. Kim, H. Kanzaria, S. Berry, and R. Brook.
Survey Instrument (PDF Format)RAND Health Care Value Survey
- Caloyeras JP et al. Understanding Waste in Health Care: Perceptions of Frontline Physicians Regarding Time Use and Appropriateness of Care They and Others Provide. Permanente Journal. Forthcoming.
- Bentley TGK, Effros R, Palar K, Keeler, EB. Waste in the U.S. Health Care System: A Conceptual Framework. The Milbank Quarterly. 2008;86(4): 629-659.
- Berwick DM, Hackbarth AD. Eliminating Waste in U.S. Health Care. JAMA. 2012;307(14): 1513-1516.
- Brook RH. The Role of Physicians in Controlling Medical Care Costs and Reducing Waste. JAMA .2011;306(6): 650–651.
- Kanzaria HK, Brook RH. The Silent Physician. Journal of General Internal Medicine. 2013;28(11):1389. 493–505.
- Korenstein D, Falk R, Howell EA, Bishop T, Keyhani S. Overuse of Health Care Services in the United States: An Understudied Problem. Archives of Internal Medicine, 2012;172(2): 171-178.
- Young PL, Olsen L. The Healthcare Imperative: Lowering Costs and Improving Outcomes: Workshop Series Summary. National Academies Press; 2010.