Here's a remarkable op-ed by my colleagues Betsy Bradley and Lauren Taylor. (Among many other things, Betsy runs Yale's Global Health Leadership Institute and Lauren is an alum of our Bioethics Summer Program.) Their piece summarizes data from a study that ran in BMJ Quality and Safety earlier this year.
The US famously spends very much more on healthcare than other countries. But the study looked at social spending more broadly, counting expenditures not only on health, but also on social services such as rent subsidies, employment-training programs, unemployment benefits, old-age pensions, family support, and so on. When those expenditures are added up, the US comes in 10th in world spending. And we're one of only three industrialized countries which spends more on health care than on those other social services. This failure to spend on social services, the op-ed claims, explains why our huge expenditures on health care don't give us good health outcomes. We'd get more health for our dollars if we offered people more social support.
A striking example from the op-ed: 119 chronically homeless people in Boston logged 18,884 emergency room visits in just five years, at a cost of $12.7 million. Perhaps if those people had had better social services, we wouldn't have had to pay for so many costly ER visits.