How Can We Improve the U.S. Health Care System?

An Evidence-Based Roadmap From Better Access to Better Outcomes

The United States does not have a shortage of health care spending.

It has a challenge converting that enormous investment into consistently better health.

According to OECD Health Statistics 2025, the United States spends approximately $14,885 per person on health care, compared with an OECD average of $5,967. Health spending consumes approximately 17.2% of U.S. GDP, compared with an OECD average of 9.3%.

Yet U.S. life expectancy is 78.4 years—2.7 years below the OECD average. Preventable mortality is approximately 217 deaths per 100,000 people, compared with an OECD average of 145. Treatable mortality is also higher: 95 versus 77 deaths per 100,000. (oecd.org)

Those numbers do not mean that American medicine is poor.

The United States has extraordinary clinicians, academic medical centers, biomedical research, pharmaceuticals, medical devices, advanced procedures, and technological innovation.

The problem is different:

How can we make the entire system work better for more people?

International comparisons and U.S. health-services research point toward several areas where improvement is possible.

1. Rebuild Primary Care

If we want fewer expensive hospitalizations, we need a stronger health system before patients reach the hospital.

Primary care provides prevention, chronic-disease management, early diagnosis, medication management, behavioral-health integration, care coordination, and longitudinal relationships.

Yet American primary care is under significant strain.

A 2025 National Academy of Medicine discussion paper noted that more than 100 million Americans in rural and urban communities experience inadequate access to primary care. Even among patients who have a regular source of primary care, the reported average wait for a family-medicine appointment was approximately 20.6 days. (nam.edu)

For hospitalists, the downstream consequences are familiar.

A patient with heart failure cannot obtain timely outpatient medication adjustment.

A patient with diabetes loses continuity of care.

A COPD exacerbation that might have been managed earlier progresses until emergency care becomes necessary.

A patient leaves the hospital but cannot get a timely follow-up appointment.

Eventually, the hospital becomes the safety net.

What could improve?

The U.S. should strengthen team-based primary care, improve access, support longitudinal relationships, integrate behavioral health and pharmacy services, expand the primary-care workforce, and move away from payment structures that undervalue coordination and prevention.

The National Academy of Medicine’s current primary-care roadmap emphasizes five areas: payment, access, workforce, digital health, and accountability. (nam.edu)

The evidence-based lesson

Primary care should not be treated as the inexpensive front office of an expensive medical system.

It should be treated as core infrastructure.

Better primary care is one of the most important foundations for better American health care.

2. Reduce Administrative Complexity

Imagine if every airline used a different passport format.

Every airport required different identification.

Every state had different rules for boarding.

And every passenger needed authorization before changing flights.

The system would technically function—but enormous resources would be wasted navigating it.

Something similar happens in American health care.

Clinicians and health systems deal with multiple:

insurance requirements,
prior-authorization processes,
formularies,
billing rules,
quality measures,
credentialing processes,
documentation requirements,
electronic workflows,
and reimbursement models.

A 2025 Commonwealth Fund analysis concluded that primary-care administrative burden is driven by factors including complex insurance requirements, poorly designed EHR workflows, prior authorization, quality reporting, inbox workload, and implementation of multiple payment models.

The report identified potential improvements including simplifying documentation and regulation, improving EHR usability, embedding forms into electronic workflows, reducing prior-authorization burden, and improving the design of value-based-care metrics. (commonwealthfund.org)

What could improve?

Standardize what can reasonably be standardized.

A serious simplification effort could address:

prior authorization, electronic claims, quality reporting, credentialing, medication approval, clinical documentation, and insurance transactions.

Not every administrative task is unnecessary. Quality assurance, appropriate utilization review, fraud prevention, documentation, and accountability all serve legitimate purposes.

The goal is not zero administration.

The goal is high-value administration.

Every hour of unnecessary administrative work is an hour of health-care resources that did not directly improve a patient’s health.

3. Make Coverage Translate Into Real Access

Having health insurance is important.

But an insurance card is not the same thing as health care.

Consider a patient who technically has insurance but faces:

a $5,000 deductible,

a specialist who is out of network,

a medication that requires authorization,

a primary-care appointment three months away,

or a treatment they still cannot afford.

That patient may be insured while remaining functionally under-accessed.

International comparisons repeatedly identify access as a major area where the United States underperforms relative to several other high-income systems.

What should we measure instead?

Not simply:

“Does this person have insurance?”

But:

“Can this person obtain appropriate care when it is needed without unreasonable financial hardship?”

That means measuring appointment availability, medication affordability, specialist access, behavioral-health access, out-of-pocket costs, network adequacy, and delays caused by insurance processes.

The evidence-based lesson

Coverage is a means.

Timely, affordable access to appropriate care is the outcome that matters.

4. Fix the Hospital-to-Home Transition

One of the most dangerous moments in health care happens after we declare the patient well enough to leave.

A discharge may look excellent in the EHR:

Medically stable. Discharge home. Follow up with PCP.

But what happens next?

Does the patient understand the medication changes?

Can the patient afford the new medications?

Did the primary-care physician receive the discharge information?

Was the specialist appointment actually scheduled?

Does the patient understand which symptoms should trigger a phone call or emergency visit?

Can the patient get transportation?

Who follows pending cultures, pathology, or imaging?

These are not minor details.

They are part of treatment.

The Agency for Healthcare Research and Quality emphasizes that safe hospital-to-home transitions require effective information transfer and patient/family engagement. AHRQ has developed evidence-based approaches including IDEAL Discharge Planning, Project RED, medication-reconciliation tools, structured handoffs, and primary-care transition strategies. (ahrq.gov)

AHRQ also emphasizes primary care’s role as an integrator following discharge, including timely bidirectional information exchange among hospitals, primary care, post-acute care, behavioral health, and social services. (ahrq.gov)

What could improve?

Every high-risk discharge should reliably answer:

Who owns the patient next?

When will follow-up occur?

Were medications reconciled?

Can the patient obtain those medications?

Who follows pending results?

Does the outpatient clinician know what changed?

Does the patient understand the plan?

For hospitalists

This may be one of the most immediately actionable health-system improvements available to us.

Discharge should be treated as a clinical intervention, not an administrative event.

5. Improve Communication Between Health Systems

American health care has enormous amounts of data.

What it often lacks is usable information at the right moment.

A patient may have:

one EHR at the primary-care office,

another at the community hospital,

another at the academic center,

another at the rehabilitation facility,

and additional records in pharmacies, laboratories, imaging centers, and specialist practices.

Interoperability has improved, but fragmentation remains clinically relevant.

AHRQ identifies transitions between emergency departments, inpatient wards, ICUs, hospitals, and outpatient settings as vulnerable periods for communication and diagnostic safety. (ahrq.gov)

What could improve?

Clinicians need rapid access to:

current medications,
allergies,
recent laboratory data,
relevant imaging,
recent hospitalizations,
pending results,
active diagnoses,
goals of care,
and the patient’s longitudinal care plan.

The goal should not simply be more data.

The goal should be the right information at the right time.

A connected health system should make the clinically important information follow the patient.

6. Move From Paying for Volume Toward Paying for Value

Traditional fee-for-service medicine has a simple economic characteristic:

More billable activity generally generates more revenue.

More visits.

More procedures.

More tests.

More admissions.

This does not mean clinicians intentionally provide unnecessary care. It means the financial architecture of a system influences organizational behavior.

Alternative models attempt to reward outcomes, population health, prevention, quality, and efficient use of resources.

But value-based care also needs caution.

Poorly designed quality metrics can create enormous documentation burden without improving outcomes. Risk adjustment can be imperfect. Incentives can create unintended consequences.

What could improve?

Payment reform should focus on a limited number of outcomes that patients and clinicians actually care about:

preventable hospitalization,
chronic-disease control,
patient safety,
appropriate utilization,
functional outcomes,
successful care transitions,
patient experience,
and avoidable complications.
The principle

Do not simply pay health systems for doing more.

Reward them for producing better health and better care.

7. Reduce Low-Value Care

More medicine is not always better medicine.

Hospitalists encounter this daily.

Daily laboratory testing after it has stopped influencing management.

Telemetry without a continuing indication.

Urinary catheters left in unnecessarily.

Acid suppression without an indication.

Imaging unlikely to change treatment.

Antibiotics continued after bacterial infection becomes unlikely.

Unnecessary consultations.

Treatments continued because nobody stopped to ask why they were started.

Every unnecessary intervention carries potential consequences:

cost,

false-positive findings,

additional testing,

adverse drug effects,

hospital-acquired complications,

and patient discomfort.

What could improve?

Make this question routine during rounds:

“Will this test or treatment change what we do for this patient?”

If the answer is no, clinicians should reconsider why it is being ordered.

This is not rationing.

It is evidence-based medicine.

High-value medicine means doing everything the patient needs—not everything medicine is capable of doing.

8. Make Medication Affordability a Clinical Issue

A medication does not work if the patient cannot obtain it.

Hospital discharge plans frequently include medications selected on clinical grounds without enough attention to affordability.

Then the patient arrives at the pharmacy.

The medication costs hundreds of dollars.

It is not covered.

Prior authorization is required.

The patient leaves without it.

Two weeks later, the patient may return to the hospital.

What could improve?

Whenever possible, prescribing systems should provide clinicians with meaningful information about:

coverage, expected patient cost, formulary alternatives, and prior-authorization requirements at the point of prescribing.

Medication reconciliation should include affordability.

Instead of asking only:

“What medications are you taking?”

Ask:

“Are there medications you are not taking because they cost too much?”

Clinical lesson

Affordability is part of pharmacology.

A theoretically optimal medication that the patient cannot obtain may be clinically inferior to an affordable evidence-based alternative the patient can actually take.

9. Invest More in Prevention—but Measure What Works

The U.S. spends enormous resources treating advanced disease.

Preventing disease earlier is attractive clinically and economically.

But “prevention” should not become shorthand for indiscriminately doing more screening.

Effective prevention means investing in interventions with demonstrated benefit:

vaccination,

tobacco cessation,

evidence-based cancer screening,

blood-pressure control,

diabetes prevention and treatment,

physical activity,

obesity management,

substance-use treatment,

and appropriate cardiovascular risk reduction.

OECD data show that the U.S. allocates about 3.6% of current health expenditure to prevention, roughly similar to the OECD average of 3.4%. That observation is important because it suggests that simply increasing a budget labeled “prevention” is not enough; effectiveness and implementation matter. (oecd.org)

The objective is not more preventive activity. It is more effective prevention.

10. Treat Mental Health and Substance Use as Health Care

Mental health frequently operates as a parallel system rather than an integrated component of American medicine.

Patients can find a cardiologist.

They can obtain advanced imaging.

They can undergo sophisticated procedures.

But finding timely psychiatric care, addiction treatment, or counseling may be extraordinarily difficult.

Hospitalists see the consequences:

alcohol withdrawal,

opioid-related illness,

overdose,

depression,

suicidality,

complications of untreated addiction,

and recurrent hospitalization.

What could improve?

Integrate behavioral health into primary care and hospital medicine.

Expand evidence-based treatment for substance-use disorders.

Initiate appropriate pharmacotherapy during hospitalization rather than automatically deferring treatment to an outpatient system the patient may never reach.

Improve transitions from emergency and inpatient care to longitudinal behavioral-health treatment.

Clinical lesson

Mental health and addiction treatment should not be optional appendices to the medical system.

They are medical care.

11. Use Technology to Give Clinicians Time Back

Technology should reduce work.

Too often it simply creates new work.

American clinicians now operate inside an environment of alerts, inbox messages, copied documentation, quality measures, authorization forms, medication reconciliation, coding queries, and EHR clicks.

Artificial intelligence could potentially help with:

clinical documentation,

chart summarization,

discharge instructions,

medication reconciliation,

patient communication,

coding support,

and administrative workflows.

But AI should not merely automate existing inefficiency.

Automating a bad process creates a faster bad process.

A better test for health technology

Before implementing a new technology, ask:

Does this improve patient outcomes?

Does it improve safety?

Does it reduce clinician workload?

Does it eliminate work—or simply move work somewhere else?

Does it introduce new errors or inequities?

The best health technology may not be the system that produces the most information.

It may be the system that gives clinicians something increasingly scarce:

time to think and time to care for patients.

12. Address Social Needs Without Pretending Hospitals Can Solve Society

Housing instability.

Food insecurity.

Transportation.

Education.

Employment.

Social isolation.

Violence.

Environmental exposure.

These factors influence health.

But there is an important distinction.

A hospital cannot solve poverty.

A physician cannot fix housing policy during a 20-minute appointment.

Health systems should therefore avoid creating another documentation burden in which clinicians identify social problems without having resources to address them.

What could improve?

Screen when there is a meaningful pathway to action.

Build partnerships with community organizations.

Integrate social workers, case managers, community health workers, pharmacists, and behavioral-health professionals into care teams.

Focus resources on social needs most likely to interfere with treatment.

Recognizing social determinants is useful only when recognition can lead to meaningful assistance.

What Would a Better U.S. Health System Look Like?

Imagine a patient with diabetes, heart failure, chronic kidney disease, and depression.

In a better system:

The patient has a consistent primary-care team.

Appointments are available when needed.

The primary-care clinician can see relevant hospital and specialist information.

Medications are affordable.

Behavioral-health care is integrated.

A pharmacist helps optimize complex medication therapy.

When the patient develops early fluid retention, the outpatient team intervenes before hospitalization becomes necessary.

If hospitalization does occur, the hospital automatically communicates important information to the outpatient team.

Medications are reconciled before discharge.

Pending results have a clearly identified owner.

Follow-up is scheduled rather than merely recommended.

The patient understands the treatment plan.

And the organizations involved are rewarded for keeping the patient healthy—not simply for generating additional encounters.

None of those ideas requires futuristic technology.

Most already exist somewhere in American medicine.

The challenge is making them normal rather than exceptional.

A 10-Point Roadmap

If we wanted a concise evidence-informed agenda for improving American health care, it could look like this:

1. Rebuild primary care.
Improve access, workforce capacity, team-based care and payment.

2. Simplify administration.
Standardize prior authorization, billing, reporting and insurance transactions.

3. Convert insurance coverage into effective access.
Measure whether patients can actually obtain affordable care.

4. Make hospital-to-home transitions safer.
Treat discharge as an active clinical process.

5. Improve interoperability.
Make essential clinical information follow the patient.

6. Align payment with outcomes.
Reward better care rather than simply more activity.

7. Reduce low-value care.
Stop tests and treatments that do not meaningfully improve management or outcomes.

8. Make medications affordable and accessible.
Include cost in clinical decision-making.

9. Strengthen prevention, mental health and addiction treatment.
Intervene before disease produces preventable hospitalization.

10. Give clinicians time back.
Use technology and administrative reform to increase time available for clinical reasoning and patient care.

What Can Hospitalists Do Tomorrow?

Health-system reform can sound too large for an individual physician to influence.

But some changes begin at the bedside.

On tomorrow’s rounds, ask:

Does this patient still need every medication on this list?

Do we need today’s laboratory tests?

Does this patient still need telemetry?

Can the patient afford the medications we are prescribing?

Does the patient understand what changed during hospitalization?

Who owns every pending result?

Is outpatient follow-up actually scheduled?

Does the primary-care clinician know what happened?

Could something have prevented this admission?

What could prevent the next one?

Those questions turn health-system improvement from an abstract policy discussion into clinical practice.

The Bigger Lesson

The central challenge in American health care may not be discovering another breakthrough treatment.

We will continue to need breakthroughs.

But we also need a system capable of reliably delivering the treatments we already know work.

The United States spends more on health care than its international peers while achieving weaker results on several population-health measures. (oecd.org)

That gap represents an opportunity.

We can strengthen primary care.

We can simplify unnecessary administration.

We can improve transitions.

We can make medications more accessible.

We can integrate mental-health and addiction treatment.

We can reduce low-value care.

We can use technology to eliminate work rather than manufacture more of it.

And we can measure success based on what ultimately matters:

Did patients become healthier?

The Bottom Line

Improving U.S. health care does not require choosing one foreign health system and copying it.

Nor does it require abandoning the strengths of American medicine.

A better strategy is to preserve what the United States does exceptionally well—innovation, biomedical research, specialty expertise, advanced treatment and clinical excellence—while systematically addressing the weaknesses repeatedly identified by U.S. and international evidence.

The future of American health care should be:

more accessible,

less administratively complex,

more coordinated,

more prevention-oriented,

more affordable,

more evidence-based,

and ultimately,

more focused on health than on health-care activity.

That is not one reform.

It is a direction.

And clinicians have an important role in determining whether the system moves toward it.

Evidence and Further Reading

OECD — Health at a Glance 2025: United States. International data on U.S. spending, health outcomes, workforce, prevention and health-system resources. (oecd.org)

National Academy of Medicine — Implementing High-Quality Primary Care in 2025. Evidence-informed priorities addressing primary-care payment, access, workforce, digital health and accountability. (nam.edu)

Commonwealth Fund — Administrative Burden in Primary Care: Causes and Potential Solutions. Analysis of administrative burden and opportunities to simplify documentation, prior authorization, EHR workflows and quality measurement. (commonwealthfund.org)

AHRQ — Resources and Tools to Improve Discharge and Transitions of Care and Reduce Readmissions. Evidence-based resources including Project RED, IDEAL Discharge Planning, medication reconciliation and care-transition tools. (ahrq.gov)

AHRQ — Primary Care-Based Efforts to Reduce Potentially Preventable Readmissions. Research examining primary care’s role in safer post-discharge care and preventing avoidable readmission. (ahrq.gov)

Educational Disclaimer

This article is intended for educational and continuing medical education purposes. Health-system performance is influenced by financing, demographics, geography, socioeconomic conditions, public policy, workforce availability and many other factors. International comparisons cannot establish that adopting a particular policy would reproduce another country’s outcomes in the United States. Policy choices involve clinical, economic, ethical and societal trade-offs and should be evaluated using multiple sources of evidence.