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These Are the Best of Times, These Are the Worst of Times …

No not that book! We are talking about the state of healthcare not just in the United States but around the world. Even though we are at the forefront of the most advanced ability to heal, a great many people are deprived of the best of care either because they cannot afford it or because they are otherwise denied access to treatment. This book is not about the social aspects of that state but about what every healthcare leader and his or her organization can do to make healthcare more available, more affordable, with better outcomes … and yes, if desired, more profitable.

The United States spends more on healthcare than any other nation in the world, yet 50.7 million people in the United States have no health coverage. In 2008, $7,681 was spent for every U.S. resident on healthcare, some $2.3 trillion, as reported by the Centers for Medicare and Medicaid Services, yet the average life expectancy in the United States is shorter than that in many developed and developing nations. In a study of the healthcare systems of seven industrialized countries, the Commonwealth Fund ranked the U.S. healthcare system as the most costly, spending almost twice as much per capita than average.

How can this be?

The healthcare system in the United States is in shambles. Emergency departments are overflowing with the uninsured. There is a shortage of primary care providers driven by lifestyle and reimbursement pressures and a rush to specialize. The Affordable Care Act could extend health insurance coverage to 32 million uninsured U.S. citizens. There are fears that there won't be enough doctors to treat the newly insured because the United States could face a deficit of as many as 150,000 doctors in the next 15 years, according to the Association of American Medical Colleges. Like doctors, nurses have been working more overtime and take care of more and more patients, leading to the exit of experienced nurses from the profession because of burnout and exhaustion. Forty percent of practicing nurses are 50 years old or older. In the journal Health Affairs, Rother and Lavizzo-Mourey project that within the next 15 years, the U.S. nursing shortage will reach a shortfall of 260,000 registered nurses. Dedicated physicians and nurses are already working against impossible odds to achieve improbable results. How will care be provided to this expanding population of patients?

The answer is not by working harder.

The United States has more modern hospitals, more skilled physicians, more specialists, and more professional nurses than any other nation in the world. Most of the advances in healthcare technology, pharmacology, and medical science have originated in the United States. Applicants to medical schools in the United States compete with applicants from other nations seeking the world's best medical education. The American ...

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