Ed. Note: Rebecca Onie is co-founder and CEO of Health Leads, a MacArthur Fellow, and a World Economic Forum Young Global Leader. Paul Farmer is the chair of the Department of Global Health and Social Medicine at Harvard Medical School, Chief of the Division of Global Health Equity at Brigham and Women’s Hospital, and co-founder of Partners In Health.
Three years after the passage of the Affordable Care Act, the U.S. is making progress on healthcare—but we are still stuck. Heated discussions about mandates, incentives, and cost curves persist. In hospitals and clinics across America, the same challenges grind on—ironically poised to become bigger now that the system will serve more patients, without any additional doctors.
The good news is plenty of nations around the world achieve better health outcomes despite severe shortages of dollars and doctors. Now that U.S. healthcare costs are approaching an eye-popping 25 percent of GDP and barely 30 percent of U.S. doctors work in primary care, it is time for us to pay attention.
The U.S. sought advice about counterterrorism from Israel after 9/11 and from Kosovo about post-disaster reconstruction after Hurricane Katrina. America needs now to look beyond our own shores to shed the healthcare inefficiencies and inequities born of habit and history.
We can learn useful lessons not from the usual comparison countries—industrialized nations with large national healthcare systems—but from resource-constrained nations which have no choice but to do more and better with less.
From Haiti and Rwanda to Mexico and Malawi, three basic truths have evolved: broadening the definitions of healthcare product, place, and provider can deliver much more for less.
Broadening the healthcare product means acknowledging that it takes more than medicine to advance health—it also takes food, heat, housing, and other basics without which health radically declines. Today, doctors in America practice a “don’t ask, don’t tell” policy when it comes to these necessities. Since they don’t know how to help with food at home, many don’t ask if there is any—even if the medicine they’re prescribing is marked “take with food.”
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