FSG's Mark Kramer and Dr. Atul Gawande discuss the untapped potential for community-based funders to transform the cost and quality of health care in the United States. Individually, these funders have the opportunity to make a profound and lasting impact on the health of their communities; together, they have the opportunity to create a national movement to achieve better outcomes at lower cost.

Discovering better ways to solve social problems

Over the past three years, Dr. Atul Gawande’s articles and books have profoundly altered thinking about the U.S. health care system. Although he has not written specifically about the role of philanthropy, his research demonstrates that the cost and quality of health care in the United States are heavily influenced by local practices, and can be profoundly influenced by community-based efforts with modest levels of funding. As a result, we see a tremendous philanthropic opportunity that has been almost entirely overlooked: hundreds of health foundations, community foundations, and corporate or family foundations are ideally positioned to lead a national movement to transform the U.S. health care system by lowering costs and improving patient outcomes in their local communities.

Most smaller, local funders have steered clear of health care reform because of the vast magnitude of health care spending and the vituperative national controversy over health care policy. In this, they have conflated access to care with the cost and quality of care. Providing access to care by addressing the needs of the uninsured is a costly and controversial national issue that cannot easily be addressed at local levels. However, Dr. Gawande’s research demonstrates that the costs and quality of care are driven by local behaviors that vary dramatically from one community to the next. Here, there is surprisingly little correlation between the cost of care and the quality of patient outcomes. Instead, Dr. Gawande cites many examples of simple and inexpensive changes in practice within local communities that have produced dramatic improvements in patient care and reductions in cost.

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