IOM: Dou­ble health spend­ing

Modern Healthcare - - THE WEEK IN HEALTHCARE - Jes­sica Zig­mond

The In­sti­tute of Medicine has am­bi­tious goals for the U.S. to trans­form its in­vest­ment in public health amid con­gres­sional bat­tles to rein in gov- ern­ment spend­ing.

In a re­port re­leased last week, the IOM rec­om­mended the U.S. at least dou­ble its an­nual fed­eral spend­ing on public health to about $24 bil­lion from its cur­rent level of about $11.6 bil­lion and floated a new health­care tax to pay for it.

De­spite “its un­ri­valed wealth,” the U.S. ended the last cen­tury be­hind many other de­vel­oped coun­tries in health sta­tus in terms of mor­tal­ity, mor­bid­ity and loss of po­ten­tial pro­duc­tiv­ity, the re­ported noted, and the IOM con­cluded that the coun­try must pay more at­ten­tion to pop­u­la­tion-based preven­tion ef­forts; fix how public health fund­ing is al­lo­cated, struc­tured and used; and make sure there is sta­ble fund­ing for public health de­part­ments.

Com­mit­tee mem­bers also sug­gested the Na­tional Preven­tion, Health Pro­mo­tion and Public Health Coun­cil con­vene ex­pert pan­els to de­ter­mine the com­po­nents and costs of a min­i­mum pack­age of public health ser­vices and called on Congress to au­tho­rize a sta­ble and long-term fi­nanc­ing struc­ture to de­liver those min­i­mum ser­vices in ev­ery com­mu­nity. The re­port pro­poses a na­tional tax on all med­i­cal-care trans­ac­tions as a way to “close the gap” be­tween the funds that are needed and the funds that are avail­able.

“This is a gov­ern­ment func­tion that needs to con­vene part­ners to make a mea­sur­able dif­fer­ence,” said Steve Teutsch, vice chair­man of the IOM com­mit­tee that pro­duced the re­port. “We’re talk­ing about $12 bil­lion. It’s re­ally not a huge amount to make a start.”

To be­gin, the re­port rec­om­mended HHS’ sec­re­tary adopt an in­terim life-ex­pectancy tar­get, es­tab­lish data sys­tems for a per­ma­nent health-ad­justed life ex­pectancy tar­get and also set a per-capita health ex­pen­di­ture tar­get to be achieved by 2030. The re­port, For the Public Health: In­vest­ing in a Health­ier Fu­ture, is the final in a three-part se­ries that be­gan in 2009 when the Robert Wood John­son Foun­da­tion asked the IOM to ex­am­ine mea­sure­ment, the law and fund­ing in public health.

Dr. Ge­orges Ben­jamin, ex­ec­u­tive di­rec­tor of the Amer­i­can Public Health As­so­ci­a­tion, said no one wants to men­tion the “T” word, but the rec­om­men­da­tion is es­pe­cially im­por­tant given re­cent cuts to the Preven­tion and Public Health Fund cre­ated in the Pa­tient Pro­tec­tion and Af­ford­able Care Act. In Fe­bru­ary, Pres­i­dent Barack Obama signed pay­roll tax leg­is­la­tion that cut the fund by about $5 bil­lion over 10 years.

“They were asked to come up with a fund­ing mech­a­nism,” Ben­jamin said of the IOM com­mit­tee. “I think that tax is a start­ing point. It’s go­ing to be an in­ter­est­ing dis­cus­sion. I think it’s im­por­tant in light of the fact that the preven­tion fund was in­tended to cre­ate a fund­ing stream for public health,” he added. “We do need to have that na­tional con­ver­sa­tion.”

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