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Commission on Investment Imperatives for a Healthy Nation

Background

The United States’ health and health care system is considered by many to be broken. Health spending is now approaching 20% of the GDP, more than $4 trillion, at least a third of which is neither needed nor useful. The paradoxical result of per capita expenditures that are double the average for comparable economies: a population health ranking below three dozen other countries. What was once viewed as a best-in-class health system has failed to deliver on the evolving understandings of the most important factors shaping health status.

The list of failures is lengthy. The majority of Americans report dissatisfaction with critical elements such as affordability, experience, and access; financial instability places hospitals across the nation at risk of closing their doors; the fiscal integrity of the Medicare program is threatened; and clinician burnout is at an all-time high. Furthermore, the devastation wrought by the COVID-19 pandemic painfully demonstrated that the system is not equipped to deliver a swift, coordinated, and effective emergency response.

At the outset of the pandemic in 2020, the National Academy of Medicine (NAM) called on members of its Leadership Consortium—composed of public and private health and health care leaders—to lead a comprehensive, real-time assessment of COVID-19’s impact on and across nine health system sectors: clinicians; patients, families, and communities; care systems; payers; public health; quality, safety, and standards organizations; research; digital health; and health product manufacturers and innovators. In addition to myriad sector-specific challenges, the work confirmed the existence of three fundamental challenges that threatened necessary performance in every sector: systemwide fragmentation, misaligned incentives, and systemic & structural inequities—plus a growing measure of distrust. Not only did these core health system vulnerabilities inhibit America’s COVID-19 response, but they continue to challenge health system improvement efforts more broadly.

To build on these learnings, the NAM has assembled the Commission on Investment Imperatives for a Healthy Nation (the Commission) to identify opportunities and priorities for creating the broad, cross-sector alignment necessary to overcome these core health system fragilities and reverse alarming trends in health system performance.

Related Documents

Commission Workstreams

The principal work of the Commission is being conducted through working groups dedicated to five critical aspects of the alignment needed.

Flowchart titled 'Commission on Investment Imperatives for a Healthy Nation' displaying the organizational structure and goals. At the top is a central box labeled 'AIMS' with goals: align Values, Incentives, Policies, and Actions to reverse declines in health and well-being. To the left and right, there are partner organizations: 'Philanthropic Coalition for Community Mobilization' for community input and execution, and 'Communication Coalition' for communication strategy. Below Aims is work streams which are divided into five areas: 1. Individual and community health goals - guiding organizational decisions and actions. 2. Health financing and accountability - supporting individual and community well-being. 3. Digital and data architecture - enabling seamless service improvement and knowledge development. 4. Inclusive, equitable systems - reinforcing national health equity. 5. Private investments in health - enhancing U.S. health and economic productivity.