HALE and hearty: Toward more meaningful health measurement in the clinical setting.

Recent major analyses of global burden of disease reinforce a familiar critique: despite vastly greater health spending than any other country, population health outcomes in the US are unacceptably poor. The Institute of Medicine estimates that we spend about $750 billion annually on health care in excess of what should achieve the observed health outcomes. Such inefficiency underlies health care's role as a central driver of long-term US fiscal instability and entails extensive publicand private-sector opportunity costs. Meanwhile, US healthy life expectancy (HALE) ranks a comparatively poor 35th and 32nd globally for women and men, respectively, in the bottom quartile and falling compared to peer developed countries. This failure of ample financial investment to produce better population health outcomes motivates a broad consensus for health care reform. While an important component of excess spending can be attributed to financing peculiarities such as distorted pricing, the accompanying poor outcomes reveal a health care system that does not efficiently deliver health. We believe that a central obstacle to achieving higher population health value in health care comes down to a measurement problem. If, as the improvement principle goes, “you can't improve what you don't measure”, then what we don't measure in health care is telling. Our health care systems’ predominant measurements focus on what can be conveniently measured from the health care perspective, but do too little to guide us to the improved health status we ultimately seek.