EPA-1438 – USA Health System Performance

Abstract

Innovative health research and highly performing, academic health centers of excellence abound in the United States. They coexist in marked contrast with the contemporary US health system that is fragmented, with a secondary and tertiary prevention, specialty focus, with little or no primary prevention, and an insufficient populations’ health focus. The consequence of such a model are unsustainable health care and health systems’ costs, rising burdens of diseases by non-communicable diseases (NCDs), multiple comorbidities, chronicity, disability, insufficient access to care. Furthermore, a sizable cluster of Americans, now in the tens of millions, who lack health insurance coverage, resort to hospitals’ emergency rooms care to meet their health care needs. It is an ineffective, discontinuous and expensive pathway exacerbating the health system's sustainability. The Affordable Care Act (ACA) enacted by the US Congress in 2009/2010, reconfirmed by the US Supreme Court in June 2012 is to be launched in January 2014. It represents a bold attempt by President Obama and his Administration to rectify the status quo. The author reviews America's health system's performance through a SWOT analysis and the solutions that are beginning to emerge in response to contemporary and urgent American and global health challenges. He presents highlights of the ACA and new American models of health promotion, illness prevention and care that are integrated, team based, responsive, continuous, of quality, accessible and affordable. Among them are the medical home, the medical neighborhood, and accountable care organizations. They are predicated on primary care, mental health and public health integration, the catalytic role that psychiatry should play in such models, and the positive consequences of such models for training, services, research and policy.