What can be more vital to each of us than our health? Yet, despite unprecedented health care spending, the U.S. health system is substantially underperforming, especially with respect to what should be possible, given current knowledge. Although the United States is currently devoting 18% of its Gross Domestic Product to delivering medical care—more than $3 trillion annually and nearly double the expenditure of other advanced industrialized countries—the U.S. health system ranked only 37th in performance in a World Health Organization assessment of member nations. In Vital Directions for Health & Health Care: An Initiative of the National Academy of Medicine, the U.S. National Academy of Medicine (NAM, formerly the Institute of Medicine), which has long stood as the nation’s most trusted independent source of guidance in health, health care, and biomedical science, has marshaled the wisdom of more than 150 of the nation’s best researchers and health policy experts to assess opportunities for substantially improving the health and well-being of Americans, the quality of care delivered, and the contributions of science and technology. This publication identifies practical and affordable steps that can and must be taken across eight action and infrastructure priorities, ranging from paying for value and connecting care, to measuring what matters most and accelerating the capture of real-world evidence. Without obscuring the difficulty of the changes needed, in Vital Directions, the NAM offers an important blueprint and resource for health, policy, and leaders at all levels to achieve much better health outcomes at much lower cost.
สารบัญ
1. Vital Directions for Health and Health Care: Priorities from a National Academy of Medicine Initiative 1
PART I: BETTER HEALTH AND WELL-BEING
2. Systems Strategies for Better Health Throughout the Life Course 43
3. Addressing Social Determinants of Health and Health Disparities 71
4. Preparing for Better Health and Health Care for an Aging Population 97
5. Chronic Disease Prevention: Tobacco, Physical Activity, and Nutrition for a Healthy Start 111
6. Improving Access to Effective Care for People Who Have Mental Health and Substance Use Disorders 135
7. Advancing the Health of Communities and Populations 153
PART II: HIGH-VALUE HEALTH CARE
8. Benefit Design to Promote Effective, Efficient, and Affordable Care 175
9. Payment Reform for Better Value and Medical Innovation 191
10. Competencies and Tools to Shift Payments from Volume to Value 221
11. Tailoring Complex-Care Management, Coordination, and Integration for High-Need, High-Cost Patients 233
12. Realizing the Full Potential of Precision Medicine in Health and Health Care 249
13. Fostering Transparency in Outcomes, Quality, Safety, and Costs 269
14. The Democratization of Health Care 289
15. Workforce for 21st-Century Health and Health Care 301
PART III: STRONG SCIENCE AND TECHNOLOGY
16. Information Technology Interoperability and Use for Better Care and Evidence 319
17. Data Acquisition, Curation, and Use for a Continuously Learning Health System 345
18. Innovation in Development, Regulatory Review, and Use of Clinical Advances 369
19. Targeted Research: Brain Disorders as an Example 395
20. Training the Workforce for 21st-Century Science 407
APPENDIXES
A. Vital Directions Steering Committee Biographies 433
B. Related Publications from the National Academies of Sciences, Engineering, and Medicine 449
C. “Vital Directions for Health & Health Care: A National Conversation” Symposium Agenda (September 26, 2016) 469
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