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Shifting From Volume to Value: Opportunities and Challenges for the Field of Orthopaedic Surgery

CURRENT STATE OF THE UNITED STATES HEALTH CARE SYSTEM For decades, health care expenditures in the United States have steadily risen, consuming an increasing percentage of gross domestic product (GDP). Meanwhile the United States has outpaced other industrialized nations with approximately 18% of US GDP currently appropriated to the health care sector. This figure has increased every year since the 1960s, and is projected to reach up to 21% by 2023. Furthermore, between 1980 and 2008, health care spending in the United States experienced a growth of 7 percentage points of GDP, versus an average 2.6 percentage points among the sum of all other non-US Organization for Economic Cooperation and Development countries.2 Thus, a critical evaluation of health care costs in the United States is crucial to the discussion of shifting to a value-driven health care system. Whether the increased allocation of resources to the health care sector, financial and otherwise, translates into improved patient outcomes, is part of the question that underlies the discussion to follow.