Why Is The U.S. Healthcare System Still Broken & How Do We Start Fixing It?

Spoiler alert: the U.S. healthcare system is horribly broken.  Okay, maybe that doesn’t actually come as much of a shock to anyone who has read a newspaper headline in America in the past fifteen years. But, if we have known this for years, why does the system continue to be at best dysfunctional?  Governments, foundations, companies, and countless individuals put billions of dollars into America’s healthcare system each year.  According to Giving USA Foundation, in 2010, Americans gave over $22B to healthcare organizations and this doesn’t count donations that filter through other organizations such as religious institutions first and this does not count government spending.  From nurses and doctors all the way up to the president of the United States, there are millions of people who are committed to creating a better healthcare system in America.  Yet, even with all these resources, healthcare costs continue to skyrocket, quality of care is inconsistent at best, and disparities among rich and poor persist.  Why?

FSG had the opportunity to explore this question when we led a collective impact workshop on June 11th for a number of state adolescent health coordinators.  Adolescent health coordinators sit in state governments and are responsible for the continuum of state services, such as pregnancy prevention, obesity awareness, and mental health services, provided to adolescents.  At the workshop, many of the coordinators described the siloed nature of their work—how they must try to work across departments and agencies that rarely speak to one another and who know little of each other’s work.  The coordinators also spoke about cuts in their funding and how they are forced to do more with fewer resources. Finally, we heard that the role the government plays is often disconnected from other healthcare players like philanthropic funders and businesses, with little coordination of services across sectors.

To us at FSG, these sounded like issues we have heard before through much of our collective impact work, and issues to which collective impact can help frame an approach to solving.  When players work together to create a common agenda, they are forced to come to the table together, thereby breaking down the silos that exist between agencies, departments, and different players.  Continuous communication ensures that different groups are aware of the actions and efforts of others.  In the collective impact model, funding becomes more leveraged because activities are not redundant but mutually reinforcing—you can actually do more with less.  To us leading the workshop, it seemed that collective impact might offer a new approach to some of the systemic issues surrounding adolescent health and the healthcare system broadly.

In fact, the coordinators agreed.  Everyone at the workshop saw some application of collective impact in their work.   However, the coordinators had very different ideas on how they might think about collective impact in their states depending about the players in the space, the resources available, the momentum around specific issues, and the existing level of collaboration.  Some saw momentum at state levels around issues like obesity or teen pregnancy, others saw a need and an opportunity to reform the state’s entire adolescent health system, and finally another saw momentum in a few specific localities. Certainly, not everyone will go back to their state and start a collective impact effort, but everyone in the room said they would approach their work and their collaborations a little bit differently.

No one believes that collective impact is going to be the silver bullet in solving all the issues surrounding the U.S. health system—they are far too complex for any one solution.  To us, however, it seems like collective impact offers an exciting new approach to addressing some of the complexities within the U.S. system. And, perhaps, it even offers an opportunity to read a positive headline or two related to healthcare in America.

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