We know that we spend more on health care than any other nation. Still, we have 50 million uninsured and very low rank among the industrialized nations for health care outcome such as infant mortality rate. With ballooning national debt and trillion dollar annual federal budget deficits, we are on an unsustainable trajectory in health care spending. Fortunately, our health care delivery system is changing. Some of the changes are the result of the new health care law, while others are the result of adaptation of new technology. The pace of penetration of technology is still lower in health care when compared to other areas. Some of the fragmentation of health care and operational inefficiencies will be reduced by the adaptation of new technologies. Although it involves large initial investments, significant long term benefits are likely. Policy and regulatory changes at various levels are also needed. Mergers and acquisition among providers are already occurring resulting in vertical and horizontal integration of health systems. Relatively small percentage of patients with multiple chronic conditions accounts for the vast majority of health care expenses. Incentives for individuals and providers are being developed to better manage chronic conditions and wellness care. Quality and outcome can be improved by the use of practice guide lines and check lists while reducing costs and improving outcome. Using technology and other tools to monitor health status of at risk individuals can result in early detection of complications so that they can be treated at home reducing hospitalization, emergency department visits and lower use of specialist services. Another low hanging fruit is tort reform. Defensive medicine accounts for up to 4% of the expenses. We need to modernize tracking of health care expenses through technology reducing administrative expenses, as well as waste and fraud. With this background, we compare and contrast the delivery of neonatal care.
Keywords: Affordable care act, Infant mortality rate, Access, Cost, CBO, Quality, Outcome, Fraud, Waste, Defensive medicine, Tort reform, Neonatal care, Low birth weight infants, NICU, Regionalization, Prematurity.