Has Employment Become the Goal of the U.S. Healthcare System?

Short piece but it lets me get back up on my favorite soapbox:

Has Employment Become the Goal of the U.S. Healthcare System?

Last year, healthcare became the largest employment sector in the U.S. The industry provides work to over 20 million people and is expected to add more than 2 million jobs in the next decade, according to the U.S. government. This means that healthcare employment is growing more than twice as fast as all other areas, including services.

In many U.S. cities health systems have the largest workforce. For example, the Cleveland Clinic is the city’s top employer with 30,000 jobs. In Detroit, healthcare employees now make up nearly a quarter of the workforce, making it the largest segment, and Henry Ford Health System had the greatest growth at 35 percent. Even in job powerhouse Massachusetts, the largest employer is hospital network Partners HealthCare with 60,000 workers. Other cities with significant healthcare employment include Houston, Philadelphia, Baltimore and Denver.

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Any attempt to tackle spending has to grapple with this problem (?). Of course, defining job growth as a problem is where things get politically fraught. It's political, it's geographical (some otherwise dying rural areas, or Rust Belt urban areas, etc etc lean very heavily on health care as their economic engine these days), it's economic. It's real intertwined and it's real hard.

Anyway, the author of this particular piece has the following observation in mind (which, I'll admit, is not where I imagined the piece was going when I clicked the link):



Namely, that when countries are compared on health + social spending, the U.S. is not an outlier at all. We just tend to do more health spending and less social spending than other nations. That's in some ways starting to change as health care providers become increasingly engaged in helping to tackle the so-called social determinants of health (the factors in our environments that powerfully shape our health, independent of our health care delivery system).

As one example, here in Massachusetts the state's Medicaid program restructured itself last year around the accountable care organization model--groups of care providers that take responsibility for the costs and quality of the care they're delivering and thus are incentivized to keep their patient populations healthy--and has put an enormous emphasis on building partnerships between care providers and social service providers to address the underlying social determinants of health. This is particularly important for Medicaid populations, who face all sorts of social issues that greatly influence their health. Zip codes have a powerful impact on health, it turns out.

Anyway, back to the piece.

One clue for the path back to more productive use of our healthcare dollars comes in a study from economist Elizabeth Bradley, formerly of Yale and now the president of Vassar College. Bradley demonstrates that the U.S. is in the middle of the pack when it comes to combined healthcare and social services spending. However, most other countries invest more on social programs such as pensions, disability, unemployment and housing. The U.S. has among the lowest ratio of social service to healthcare expenditures. Bradley concludes that limited attention to the social determinants of health may be a significant contributor to poor outcomes in our country.

Simply spending less on healthcare would cost jobs—and that’s bad for health, Bradley says. But shifting the balance toward social services while maintaining a similar level of overall spending could help us rein in healthcare spending and get better results. In addition to examining expenditures, we should consider reversing our underinvestment in social determinants of health in order to achieve positive results in both health and employment.

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Rebalancing might be a good idea, but I'll be honest I'm not clear what it means in practical terms, particularly when talking about the employment problem. If a hospital employs more social workers and fewer billing clerks that's probably a good thing in the long run but I'm not sure most billing clerks are well-suited to social work.

Greenbeard said:

Short piece but it lets me get back up on my favorite soapbox:

Has Employment Become the Goal of the U.S. Healthcare System?


Any attempt to tackle spending has to grapple with this problem (?). Of course, defining job growth as a problem is where things get politically fraught. It's political, it's geographical (some otherwise dying rural areas, or Rust Belt urban areas, etc etc lean very heavily on health care as their economic engine these days), it's economic. It's real intertwined and it's real hard.

Anyway, the author of this particular piece has the following observation in mind (which, I'll admit, is not where I imagined the piece was going when I clicked the link):

Namely, that when countries are compared on health + social spending, the U.S. is not an outlier at all. We just tend to do more health spending and less social spending than other nations. That's in some ways starting to change as health care providers become increasingly engaged in helping to tackle the so-called social determinants of health (the factors in our environments that powerfully shape our health, independent of our health care delivery system).

As one example, here in Massachusetts the state's Medicaid program restructured itself last year around the accountable care organization model--groups of care providers that take responsibility for the costs and quality of the care they're delivering and thus are incentivized to keep their patient populations healthy--and has put an enormous emphasis on building partnerships between care providers and social service providers to address the underlying social determinants of health. This is particularly important for Medicaid populations, who face all sorts of social issues that greatly influence their health. Zip codes have a powerful impact on health, it turns out.

Anyway, back to the piece.



Rebalancing might be a good idea, but I'll be honest I'm not clear what it means in practical terms, particularly when talking about the employment problem. If a hospital employs more social workers and fewer billing clerks that's probably a good thing in the long run but I'm not sure most billing clerks are well-suited to social work.

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Well.. there certainly is something to that. I have pointed out that there are multiple ways that other countries cost shift.. which reduces their healthcare costs.

the worker at hard labor in the US.. get s a total knee surgery at 60 and keeps working until 67.

the worker at hard labor say in france.. retires on pension 5 years before his knee goes bad.. the state pays the pension.. but the state may not pay for a total knee.

the question is whether its cost effective. and there are other economic factors.. does removing this fellow from the workforce.. hurt or help the economy? It reduces work capacity on one hand..

On the other.. it opens avenues for younger people to get jobs..

The problem with the whole thing.. is that in a sense.. its preventative medicine... and while we give great lip service to preventative medicine.. we REALLY don;t practice it here in the states.. and the worst insurances for preventative health? Tend to be medicare, VA and Medicaid.