Reducing waste in US health care systems.

AN EPIDEMIC OF WASTE BLIGHTS THE US HEALTH CARE delivery system. Despite a huge dedication of resources to health care in the United States, the medical system does not deliver safe, effective, efficient, patient-centered, timely, and equitable care as recommended by the Institute of Medicine. Specifically, the US health care system is not safe: 50 000 to 100 000 or more lives are lost each year because of medical error, and 42% of respondents to a public survey reported experience with poorly coordinated, inefficient, or unsafe care. The system is not effective: 45% of recommended care is not provided, without regard to presence or type of insurance payment, and Medicare and Medicaid, which pay for about half of the compensated care in this country, do not significantly reward higher-quality care outcomes or clinicians. The system is not efficient: three fourths of adults believe the US health care system needs either fundamental change or complete rebuilding and that expanding insurance and controlling costs should be top priorities for federal action. Health problems among US working-age individuals and their families cost an estimated $260 billion in lost productivity each year. The system is not patient-centered: half of middleincome and lower-income families report serious problems paying for health care and insurance coverage. The system is not timely: an estimated 16 million Americans are considered underinsured because they have high out-of-pocket costs relative to their income. Lack of adequate coverage makes it difficult for individuals to obtain the health care they need and burdens them with large medical bills when they do receive care. And the system is not equitable: nearly 47 million US residents do not have health insurance—1.4 million more than last year, or 15.9% of the US population, according to the Census Bureau 2006 annual report on the well-being of Americans. The US health care delivery and financing systems urgently need redesign, including refocusing on patients as the primary “customers,” emphasizing clinical and service outcomes as value, using evidence-based biomedical interventions as tools, and adopting rigorous quality improvement methods to achieve efficiency in clinical microsystems.