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Innovations in Care Delivery to Slow Growth of US Health Spending

Arnold Milstein, MD, MPH; Stephen Shortell, PhD, MBA, MPH
JAMA. 2012;308(14):1439-1440. doi:10.1001/jama.2012.12659.
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The United States needs to slow its rate of growth in inflation-adjusted per capita health spending by 2.5 percentage points annually without sacrificing health or slowing biomedical technology advances.1 The consequences of failure may include shifting of funding away from resources for elementary and high school education, infrastructure (such as highways), and basic science research, as well as weakening the global competitiveness and financial health of US workers and their employers. One approach lies upstream—the prevention of disease by mitigating underlying environmental, social, and behavioral health risks. The most immediate progress is likely to come downstream from innovations that safely and compassionately lower health spending by reducing the cost of hospitalization for all patients and its unplanned occurrence for the 5% of individuals who incur half of health care expenditures in the United States.2 Opportunities include preventing expensive health crises among medically fragile patients, helping patients in late stages of serious illness avoid dying in a hospital, increasing patient flow through hospitals to lower average fixed cost per hospitalization, and reducing hospital readmissions.

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