Healthcare in the United States [Neurosurgery Wiki]

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====== Healthcare in the United States ======
The [[healthcare system]] spending in the [[United States]] reached $2.8 trillion, nearly $9000 per person, in 2012
((Centers for Medicare & Medicaid Services. National Health Expenditures 2012 Highlights 2012. Available at http://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/downloads/highlights.pdf. Accessed February 4, 2014.)).
Prior studies have suggested disparities in [[quality]] of healthcare and time to treatment across socioeconomic groups. Such differences can be of greatest consequence in the setting of emergent medical conditions. 

The United States spends more of its gross domestic product on Healthcare than any other country in the world
((World Health Organization. World Health Statistics 2011. Geneva, Switzerland: World Health Organization; 2011.)).
Hence, healthcare economics reform has dominated the US political scene, and healthcare reforms will continue to shape patient care and physician practices. To direct healthcare reform, national organizations have implemented initiatives to address waste in the medical field.

Given the quantum changes that are happening to the healthcare system in the United States, there has never been more of a need for quality data in almost every facet of [[neurological surgery]]
((http://journals.lww.com/neurosurgery/Fulltext/2015/01000/Choosing_Wisely___A_Neurosurgical_Perspective_on.1.aspx#P39)).

The [[United States]] spends nearly 18% of its gross domestic product on [[Healthcare]] (approximately $3.3 trillion), far more than any of the other 34 countries in the [[Organisation for Economic Co-operation and Development]] (OECD), and this gap is widening
((Chen A, Goldman D: Healthcare spending: historical trends and new directions. Annu Rev Econ 8:291–319, 2016)) 
((Hartman M, Martin AB, Espinosa N, Catlin A: National Healthcare spending in 2016: spending and enrollment growth slow after initial coverage expansions. Health Aff (Millwood) 37:150–160, 2018)).

The unsustainability of healthcare expenditures in the United States is widely understood, as they now represent 18% of the gross domestic product (GDP). Surgical care alone accounts for 7% of GDP, which puts a premium on strategies that can reduce costs in that arena
((Adamson T, Godil SS, Mehrlich M, Mendenhall S, Asher AL, McGirt MJ. Anterior
cervical discectomy and fusion in the outpatient ambulatory surgery setting
compared with the inpatient hospital setting: analysis of 1000 consecutive cases.
J Neurosurg Spine. 2016 Jun;24(6):878-84. doi: 10.3171/2015.8.SPINE14284. Epub
2016 Feb 5. PubMed PMID: 26849708.
)).
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With increasing [[Healthcare]] cost threatening the stability of the [[USA]] economy, policymakers and Healthcare providers have shifted focus on pay-for-performance and value-based purchasing. Current Healthcare reforms are scrutinizing all interventions and call for a reduction in the number of [[procedures]] and treatments that are less effective, more costly, and of little “value.” Because the Healthcare value equation [[cost effectiveness]] is being used to drive policies and Healthcare reforms, accurate measurement of real-world effectiveness is of utmost importance. Prospective registries have emerged as a feasible way to capture and measure real-world effectiveness via patient-reported outcomes incorporating multiple domains of patients’ general health status, disease-specific health, and societal productivity. As compared with a randomized controlled trial (RCT), prospective longitudinal 
registries are more feasible and may more closely reflect daily clinical situations, as they measure real-world care 
and are not artificially constrained by research settings, strict inclusion/exclusion criteria, and loss of patients not 
consenting to participate in clinical trial.