National Minority Quality Forum
Financial Risk vs. Patient Risk
Healthcare Financing
and Premature Deaths

The single most important purpose of our healthcare system is to reduce patient risk for an acute event — for hospitalizations, emergency room visits, disabilities and mortality while improving the quality of life.

Every patient who enters a healthcare system enters with the expectation that the system is going to mitigate their risk for an acute event. No patient seeking care understands that the care being delivered will be so suboptimal that it puts them at risk for a poor health outcome.

If we do honest accounting, however, it will be found that healthcare financing plays a significant role in increasing patient risk for acute events and premature deaths, particularly for the poor.

Every patient who enters a healthcare system enters with the expectation that the system is going to mitigate their risk for an acute event. No patient seeking care understands that the care being delivered will be so suboptimal that it puts them at risk for a poor health outcome.

If we do honest accounting, however, it will be found that healthcare financing plays a significant role in increasing patient risk for acute events and premature deaths, particularly for the poor.

Two essential pillars
of our health
system are moving
in opposite
directions.
System in Conflict

One pillar is an energetic, robust research and discovery enterprise that has created a golden age of medical innovation, in which the development of new treatments and cures is approaching exponential growth, enhancing our ability to conserve high-quality long lives.

The other pillar is our healthcare finance and delivery system. It relies on outdated financial risk mitigation models, which define high value as treatments that meet financial objectives even if they are clinically inferior. This prioritization of financial risk over patient risk has the net effect of raising patient risk for acute events. 

These financial risk management models routinely deny patients access to innovative therapies. Therein lies the conflict between innovation and payment with the inequities as a natural byproduct.

These financial risk management models routinely deny patients access to innovative therapies. Therein lies the conflict between innovation and payment with the inequities as a natural byproduct.

Compare Financial Risk Management to Patient Risk Management
Reimagining Healthcare
Financing

The signals are clear: any attempt to eliminate inequities in our healthcare system, to improve the quality of care being delivered while lowering the number of acute events and premature deaths associated must begin with a reimagining of our healthcare financing and delivery system.

The new order must be built on two principles that cannot be violated: Every patient should have access to appropriate care, and healthcare financing should not elevate a patient’s risk for a poor outcome or a poor quality of life. Summarized: Do no harm. Based on these predicates, financial risk management models that deny access to appropriate care and thereby increase patient risk for an acute event should be designated as financial determinants of health and their negative consequences must be reportable events.