From the Dean: Chronic challenges in the U.S. health system
The performance of the U.S. healthcare system has been on my mind recently, likely due to the intersection of two factors. The first was the publication a few weeks ago of a study sponsored by the Commonwealth Fund entitled Mirror Mirror 2024: A Portrait of the Failing U.S. Health System. The second was the visit to UND and the SMHS earlier this week by Dr. Eliseo J. Perez-Stable, Director of the National Institute on Minority Health & Health Disparities at the National Institutes of Health (NIH).
The Mirror Mirror article’s lead author is Dr. David Blumenthal, who was the president of the Commonwealth Fund until 2022 when he stepped down after a 10-year run. Some of you may remember when Dr. Blumenthal visited us a number of years ago as part of the SMHS Dean’s Hour series. In his recent article, he and his colleagues compared the performance of the health systems in 10 countries, including the U.S. They analyzed 70 health system performance measures and then grouped them into five domains: access to care, care process, administrative efficiency, equity, and health outcomes. They concluded that three countries – Australia, the Netherlands, and the United Kingdom – topped the list of high performers, although all nine countries except the U.S. were grouped relatively closely together. The one striking outlier was the United States, where the authors concluded that our “health system performance is dramatically lower” than that of our cohorts. This is especially vexing since the U.S. spends more on healthcare than any other country in the world – almost five trillion dollars per year!
This was the eighth in a series of publications on this topic by the Commonwealth Fund since 2004. Yet it is disappointing that over the past two decades this independent assessment of U.S. health system performance still identifies significant areas for improvement. No doubt part of the issue is the less-than-universal health insurance coverage available in the U.S. For his part, Dr. Perez-Stable cited insurance and access issues among various underserved groups as he referenced his own extensive research as an investigator and what he has learned since assuming his leadership post at the NIH back in 2015. Dr. Perez-Stable came to the U.S. from Cuba many years ago, and that likely gives him a unique perspective on some of the healthcare challenges faced by minority populations. His visit to UND, jointly sponsored by the Office of the Vice President for Research & Economic Development and the SMHS, included a discussion with students and a separate meeting with faculty. Dr. Perez-Stable pointed out the worse health outcomes, including life expectancy, for various populations, with American Indian/Alaska natives at the bottom of the list when the health of different populations are compared. To that point, following his visit to UND, Dr. Perez-Stable spent yesterday visiting the Spirit Lake Nation with Dr. Dave Wilson, associate vice president for health research at UND and chair of our school’s Department of Indigenous Health.
I think the take-home message for the SMHS regarding the entire topic of suboptimal health outcomes is that we need to continue to educate our students on these issues and challenge them to help be part of the remedy (or, rather, remedies). That’s why the visit by someone as influential as one of the directors at the NIH is so important. Thanks to Dr. Wilson for arranging the visit, and special thanks to Dr. Perez-Stable for visiting North Dakota.
Joshua Wynne, MD, MBA, MPH
Vice President for Health Affairs, UND
Dean, UND School of Medicine & Health Sciences
