Slashing the Price of Health With Common Sense

Many U.S. medical systems are using medical-legal partnerships to help disadvantaged patients who need help navigating problems with landlords and insurers that interfere with their health.

Community health workers have long been helping people navigate the intersection of health care and social services in the United States, such as in Philadelphia, where one program stands out for its overall design and continuous rigorous evaluation. Studies of the program indicate that those who worked with community health workers improved their overall health compared to those who received standard care. Now, as many cities navigate the Covid-19 pandemic, some officials see an opportunity to expand the workforce to also provide "social, material and psychological support."

Maryland's health care system is based on three pillars – all-payer rate setting, a global budget, and total cost of care – that, together, have shown positive results both for the patients and for the state's hospitals. Although evidence of success with regard to health care costs is limited, the model of incentiving investment in community health and preventive care has shown success in reducing readmission rates for hospitals across the state.

Unlike other states, Connecticut is running their own medicaid program. The state is reducing costs by reaching out to people before they get severely sick. They’re using their extensive medicaid data, looking for people who face a greater risk of getting a disease, reaching out to them, and connecting them with preventative care. “The state’s per-patient spending on Medicaid dropped by an average of 5.7 percent each year between 2010 and 2014.”

Hidalgo Medical Services is a nonprofit public health clinic that has set out to develop a model for delivering quality, affordable health care to rural communities through a comprehensive approach that addresses multiple patient needs at once.

The United States now has a variety of federally-supported nutrition programs, but the health care system remains disconnected from the social determinants of health. Many doctors simply lack the resources to provide the comprehensive care proven to have greater impact on health than strictly medical treatment. A group called Health Leads is training young volunteers to treat the social factors, like poor nutrition and housing needs.

Three hospitals throughout Mississippi rank at the top for having the lowest number of C-sections in first-time, full-term pregnancies. The hospitals achieved this by making midwife care a regular part of the birthing experience, despite not having a midwifery certification program in the state.

Rural hospitals across the country often struggle to stay open in states where Medicaid has not been expanded, but a method known as "swing beds" has helped two critical-access hospitals in Georgia to avoid this fate. This method, which allows hospitals to swing beds from "only patients in need of acute care to those who no longer require the emergency department but still needed more treatment before a nursing home," allowed for the hospitals to pay off debt and expand services.

Switzerland is home to the world's lowest avoidable mortality rate and residents of the country live longer lives and are healthier than those who live in the United States. Health policy experts credit the Swiss health care system for playing a significant role. Despite the high cost and the penalty for not carrying insurance, the system is praised as guarateeing access to quality health-care and "unlike the U.S., people rarely go bankrupt from medical bills."

Health care in the Netherlands relies heavily on the collaboration, cooperation, and shared responsibility between private markets and government regulations to achieve affordable, consistent, and quality care for patients. Although the system is not without its limitations, this process has helped the country avoid preventable deaths while also guaranting nearly all residents insurance.