Dzau, V.J., McClellan, M.B., McGinnis, J.M., Burke, S.P., Coye, M.J., Diaz, A., … Daschle, T.A. (2017). Vital directions for health and health care: Priorities from a National Academy of Medicine initiative. Journal of the American Medical Association, 317(14), 1461-1470.

Year: 2017


This article sought to review the most salient health challenges and opportunities facing the United States, to identify practical and achievable priorities essential to health progress, and to present policy initiatives critical to the nation’s health and fiscal integrity. Through a qualitative synthesis of the National Academy of Medicine white papers, authors found that the US health system faces major challenges. Health care costs remain high at $3.2 trillion spent annually, of which an estimated 30% is related to waste, inefficiencies, and excessive prices; health disparities are persistent and worsening; and the health and financial burdens of chronic illness and disability are straining families and communities. Concurrently, promising opportunities and knowledge to achieve change exist. Across the 19 discussion papers examined, 8 crosscutting policy directions were identified as vital to the nation’s health and fiscal future, including 4 action priorities and 4 essential infrastructure needs. The action priorities—pay for value, empower people, activate communities, and connect care—recurred across the articles as direct and strategic opportunities to advance a more efficient, equitable, and patient- and community-focused health system. The essential infrastructure needs—measure what matters most, modernize skills, accelerate real-world evidence, and advance science—were the most commonly cited foundational elements to ensure progress.

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