By Dr. Mark S. Roberts

This is an uncertain time for the U.S. health care system.

Substantial reforms in health care financing initiated under the Affordable Care Act are under intense scrutiny by Congress and there is a reasonable likelihood that many of the provisions of that Act will be changed. Also, components of the ACA have already resulted in a large expansion in the number of people with insurance in the U.S., with as many as 21 million individuals having insurance through both the health care marketplaces and the expansion of state Medicaid programs. Clinical and technological advances continue to change the face of medicine, with new drugs that can eliminate hepatitis C, and genetic tests that can identify many different risks as well as provide information on what treatments are more likely to be effective in a series of cancers.



However, these advances have also increased the complexity and costs of the U.S. health care system.

These changes assure that health care will continue to consume an increasing share of our financial resources.

The U.S. spent over $3 trillion on health care in 2015, accounting for more than 17 percent of GDP, a level of spending that renders the U.S. health care industry among the largest industries in the country. Spending on health care has been increasing faster than spending on many other industries. We spend much more on health care for our citizens than any other country, on a per capita basis or as a share of GDP, yet when compared to other developed economies, our health care system produces poorer outcomes.

Also of concern is that there appears to be tremendous variability in how otherwise similar patients are treated, and the source of the variability appears to be driven by the characteristics of clinicians and health systems rather than specific characteristics of the patients being treated.

These challenges have been a driving force in the increasing use of evidence-based protocols and guidelines in the care of patients. There is good evidence that guideline-driven care improves quality and reduces costs and has become a foundation of many efforts to evaluate and reimburse clinicians and health systems based on the quality of their care rather than simply on the volume of services they provide. Understanding what constitutes good evidence, and how to apply evidence-based analysis to problems in health care are important components of the training of future leaders in the field.

The importance of the health care industry as a factor in the economy, and the large impact that business and finance has on how the U.S. health care system operates, has prompted the University of Pittsburgh to develop and offer a joint program that leads to a combined MHA/MBA degree. The overarching philosophy of this combined program is that future managers and leaders in the organization and delivery of health care services can benefit from the combined expertise of the two schools, blending content knowledge in the organization, financing and measuring of quality and outcomes in health care, with the strong financing, marketing and strategic management expertise of a business school. We are confident that the combination of these competencies and skills are what health care leadership needs, to address the problems facing us today.

I once heard a hospital administrator discussing the financial health of a nonprofit hospital with that hospital’s medical staff, and he said something like, “even though you are a nonprofit, you have to behave like a business. If you have no margin, you have no mission.”

It’s certainly a mantra often used to justify the application of business strategies to health care. However, if you translate that into manufacturing it would read, “if we don’t make a profit, we don’t have a product,” which is exactly backwards.

If a company doesn’t have a high-quality, competitive product, it will not make a profit, and will not survive.

In health care, what will make an organization successful is the production of high-quality, efficient, cost-effective care. We have created a training program that we believe is a blend of the best of both worlds: strong quantitative and management business skills and deep content knowledge about the quality, financing and reimbursement of our health care system.

About the author: Mark S. Roberts, M.D., MPP is a practicing internist and chair of the Department of Health Policy and Management at the University of Pittsburgh Graduate School of Public Health. He has conducted research and cost-effectiveness analyses on many problems in health care, and has served in a senior management role in several health care organizations.