Controlling U.S. health spending: opportunities for academic health centers

This article begins by examining the factors that explain the level and rate of increase in health care spending. Expenditures per capita for health care in the United States are more than double the expenditures per capita in Canada, the United Kingdom, France, and most other industrialized countries. The main reason for the higher expenditures is not that Americans have access to or receive more health care, but that the prices Americans pay for medical services are two to three times higher than the prices in other industrialized countries. The author examines three actions that leaders of academic health centers (AHCs) could take that could reduce the burden of these higher costs on the American public. First, leaders of AHCs could compare the costs in their hospitals to the costs in comparable hospitals in other countries to find out why hospitals in the United States are so much more expensive. Second, they could examine how much they charge the uninsured for hospital services at AHCs-generally two to ten times more than they charge people with insurance. Third, including more people with multiple chronic conditions in clinical trials could make the findings of the clinical trials applicable to a larger patient population and thereby reduce the substantial geographic variation of health care that exists in the United States.