• The system doesn’t know what it knows. Despite all our sophisticated scientific and diagnostic technology, health care doesn’t have its own integrated IT system. For instance, do you consistently get a postcard from your doctor reminding you to come in for a mammogram or colonoscopy? Jiffy Lube does a better job of managing its customer information.
• The system doesn’t teach the right things. Medical education reinforces process and procedure with more vigor than it promotes cutting-edge quality of care, teamwork and demonstrably positive patient outcomes.
• The system’s costs keep rising. Although the rate of health care spending finally slowed in 2003,(5) overall costs in the health care system have steadily increased over time. Health insurance premiums have jumped 10 to 20 percent each year. The cost of prescription drugs is up nearly 30 percent over three years, five and six times the annual rate of inflation. At least 25 percent of hospital spending is on administrative costs, more than twice that of Canadian
  hospitals.(6)
• The system is voracious. Overshadowing all else, health care’s share of our gross domestic product—now about 15 percent—will push to at least 18 percent by 2012 if nothing changes. With deepening federal deficits and an inconsistent economy, the burden already falls heavily on families and employers.

COMPOUNDING THE CHALLENGE: Major public and private sector players over the past decade have failed to fulfill the country’s hopes for meaningful change. Instead, they have settled into a no-fault zone in which everyone is responsible and no one is accountable. This is the quality context much closer to the ground:

• The purchasers of health care in government and business are confounded by a payment system that fixates on curtailing care and saving money. The high price of such shortsightedness: the big health purchasers fail to recognize and reward what it takes to improve the health industry itself—superior safety and overall value for the care that is delivered.