Health Care in the United States: What’s the Underlying Problem?

May 2014 • Volume 118 • Number 5 Copyright © 2014 International Anesthesia Research Society DOI: 10.1213/ANE.0000000000000190 HEALTH CARE IN THE UNITED STATES: WHAT’S THE UNDERLYING PROBLEM? Health care has been a subject of national debate in the United States for the past decade, as we are facing a crisis in both the quality and the cost of delivered care. Why are health care costs in the United States so high, yet key quality indicators are lagging? The answer is complex and multifactorial, but perioperative care is one major example of the dilemma of high cost, low quality, and thus marginal value of health care in the United States. Indeed, it is generally accepted that our current perioperative system is plagued with high costs, complications, longer than necessary lengths of stay, excess readmissions, and financial incentives to perform surgery.1–6 The Perioperative Surgical Home (PSH)3,7 is a practice model that has been proposed as one of the potential solutions to our fragmented and costly perioperative system. The PSH is defined by the American Society of Anesthesiologists as “a patient-centered and physician-led multidisciplinary and team-based system of coordinated care that guides the patient throughout the entire surgical experience”.a,3,7,8 The overall goal of the PSH is to provide improved clinical outcomes and better perioperative service at lower cost. The purpose of this The Open Mind is to detail how the PSH model will achieve these goals and how the specialty of anesthesiology may benefit from this practice model.