1: Health Care
Improve the safety, quality, affordability, and accessibility of health care, including behavioral health care and long-term
care.
Other Information:
The system needs to make progress in providing the excellent quality of care that all Americans deserve. Today, disease, illness,
and disability can be as much a threat to Americans’ financial well-being as they are to Americans’ physical and mental well-being.
Every American deserves reliable, high-quality, and reasonably priced health care that will be there when it is needed. Health
care has to be available, affordable, portable, transparent, and efficient. Health care in the United States is second to
none, but it can be better. Although our Nation’s health care facilities and medical professionals are the best in the world,
improving quality, constraining costs, and providing greater access remain key priorities. Americans spend an increasing share
of their income on health care. Health care spending in America has increased from 5 percent of Gross Domestic Product (GDP)
in 1960 to more than 16 percent in 2006, and is predicted to continue to rise. The increasing burden of health spending on
the U.S. economy is unsustainable. Higher spending on public programs such as Medicare and Medicaid strains Federal and State
budgets. Higher insurance premiums burden workers with higher health costs and pose a challenge for employers to cover both
wage increases and health insurance premiums. The system needs to make progress in providing the excellent quality of care
that all Americans deserve. We need to increase the rate at which patients receive recommended services and to reduce the
number of unnecessary services. We also must eliminate preventable medical errors. Forty-six million Americans do not have
health insurance. These individuals may face barriers to obtaining timely and continuous care. Because of their limited access
to the system, their health problems may become more severe and further increase health care costs in the future. One critical
part of HHS’s strategy to address these problems is to improve transparency within the health care system. Because third parties
such as insurance companies, employers, and governments finance the vast majority of health care spending, most Americans
do not know—and do not have access to information about—the cost and quality of health care services in order to decide whether
they want to receive those services. Making health care affordable, accessible, and high quality depends on providing consumers
with the knowledge they need to make informed choices about their health care coverage. The Federal Government must lead in
accomplishing these objectives. We are encouraged that others in the private sector have joined in such efforts; we will continue
to pursue these goals, which characterize a value-driven health care system. The increasing costs of health care services,
our increasingly older population with multiple chronic conditions, and an increasingly complex health care system challenge
us to continue our efforts to develop new strategies to maintain safe and affordable services designed to meet Americans’
needs in their various income, family, and health circumstances. HHS is working to improve the efficiency and quality of health
care that it finances and delivers. Promoting greater use of health information technology will ensure that accurate and timely
information on a patient’s condition is available to all providers involved in the patient’s care and will reduce unnecessarily
redundant diagnostic tests and office visits that add to health care costs. Implementation of value-based purchasing systems
that include incentives to providers for treatment outcomes, rather than just reimbursements for treatments, will again help
move the system toward more efficient and cost-effective provision of care aimed at improving the health and quality of life
of the citizens touched by HHS programs. At the same time, we must ensure that our efforts to reduce the cost of high-quality
health care are reflected in more affordable and accessible health insurance coverage, to address the problem of the Nation’s
growing number of citizens without health insurance. HHS continues to explore options for increasing the portability and accessibility
of health insurance through innovative vehicles such as Health Savings Accounts coupled with high-deductible health plans,
which have grown in popularity in recent years. Additionally, HHS is working to increase access to private health insurance
for those who do not yet have it through initiatives such as Affordable Choices. Together, these initiatives will assist individuals
in maintaining their health and prevent health spending from overburdening the economy. Finally, the need to rebuild the health
care infrastructure in New Orleans in the wake of Hurricane Katrina offers the Department and its State and local partners
the challenge of coordinating coverage; system capacity; and workforce recruitment, retention, and development in new ways
that result in a revitalized health care system for that community. Strategic Goal 1, Health Care, targets the need for people
to be able to obtain and maintain affordable health care coverage; receive efficient, high-quality health care services; and
access appropriate information for informed choices. HHS’s Administration on Aging (AoA), Agency for Healthcare Research and
Quality (AHRQ), Centers for Medicare & Medicaid Services (CMS), Health Resources and Services Administration (HRSA), and Indian
Health Service (IHS) have significant roles to play in realizing this goal. In addition, the Food and Drug Administration
(FDA), Office of the Assistant Secretary for Planning and Evaluation (ASPE), Office for Civil Rights (OCR), Office on Disability
(OD), Office of Public Health and Science (OPHS), and Substance Abuse and Mental Health Services Administration (SAMHSA) play
roles in addressing this goal. There are four broad objectives under Health Care: * Broaden health insurance and long-term
care coverage; * Increase health care service availability and accessibility; * Improve health care quality, safety, cost,
and value; and * Recruit, develop, and retain a competent health care workforce. Below is a description of each strategic
objective, followed by a description of the key programs, services, and initiatives the Department is undertaking to accomplish
those objectives. Key partners and collaborative efforts are included under each relevant objective. The performance indicators
selected for this strategic goal also are presented with baselines and targets. These measures are organized by objective.
Finally, this chapter discusses the major external factors that will influence HHS’s ability to achieve these objectives,
and how the Department is working to mitigate those factors. Meeting External Challenges: HHS faces a number of challenges
in improving the safety, quality, affordability, and accessibility of health care, including shifting demographics, changing
trends in demand, increasing costs, and continuing concerns about implementing new technologies. Demographic changes include
the aging of the Nation’s population and increasing life expectancy, a growing number of persons with disabilities, and an
increasing number of populations who do not speak English and have low literacy. HHS is working to meet the challenge by targeting
its outreach materials and media responses to these populations, monitoring trends in access and availability of care for
these populations, and continuing to design and implement innovative demonstration programs and initiatives aimed at reducing
disparities. For more information about this topic, see Chapter 4’s In the Spotlight: Demographic Changes and Their Impact
on Health and Well-Being. With these demographic changes, changes in demand are expected to follow. Enhanced outreach to new
populations means that HHS may need to think differently about responding to demands for high-quality, high-value, and accessible
health care; behavioral health care; and long-term care. Surges in the Medicare-eligible population related to the aging of
the Baby Boomers may strain the ability of the health care delivery system to respond appropriately. Even consumer perceptions
about their need for preventive screenings or services impact overall demand. HHS is working to analyze background data from
services provided to react to changing beneficiary needs. Evidence-based processes are being utilized to address coverage
issues. Education campaigns are being conducted to raise awareness about beneficiary screening services and preventive care,
with particular attention to growing racial and ethnic minority populations. Although the above is true, one cannot assume
that all costs are avoidable. Some of these costs substitute for the costs of excess mortality or morbidity. The United States
continues to have the highest per capita health care spending among industrialized countries. The health care cost per capita
for persons aged 65 years or older in the United States is three to five times greater than the cost for persons younger than
65, and the rapid growth in the number of older persons, coupled with continued advances in medical technology, is expected
to create upward pressure on health care and long-term care spending. Medical inflation also contributes to the rising cost
of providing appropriate quality health services, widening the gap between increased need and available resources. An economic
downturn could increase demand for health care and long-term care services from safety net providers and strain the ability
of current providers to meet the demand. In response to these concerns, HHS will continue to monitor trends in access to care
among uninsured, underinsured, and low-income individuals, and to design and implement innovative demonstration programs that
seek to improve health and access to care among these groups. HHS will identify new resources to meet increased demands, focusing
on efficiency and effectiveness of health care service delivery. HHS will also continue to cultivate a strong focus on prevention
and wellness services (see Strategic Goal 2, Objective 2.3, for more detail). Improving health care and the health of the
population through the adoption of health information technology (health IT) is clearly a priority for HHS (see In the Spotlight:
Advancing the Development and Use of Health Information Technology). The nationwide implementation of an interoperable health
IT infrastructure has the potential to lower costs, reduce medical errors, improve the quality of care, and provide patients
and physicians with new ways to interact. However, nationwide health IT adoption can be accomplished only through a coordinated
effort of many stakeholders, from State and Federal governments and the private sector. HHS has taken great care to engage
representatives from all of these sectors in all of our health IT initiatives—an effort that involves many processes and the
work of many hundreds of participants. In September 2005, HHS formed a Federal Advisory Committee (subject to the Federal
Advisory Committee Act of 1972 (Public Law 92-463), as amended), the American Health Information Community (AHIC), to advise
the Secretary on how to accelerate the development and adoption of health IT and help advance efforts needed to achieve the
President’s goal for most Americans to have access to secure electronic health records by 2014. Additionally, the AHIC provides
input and recommendations to HHS on how to make health records digital and interoperable and how to protect the privacy and
security of those records, in a smooth, market-led way.
Objective(s):
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