This morning’s New York Times has an interesting – and perhaps transformational – opinion piece on the approach to measuring the effectiveness of health care dollars in our system, vis-a-vis the often cited “other industrialized countries.  It is definitely worth a read.

The basic premise is that health care, which for many is essentially an illness or disease treatment system, must be considered within the context of what causes the illness or disease.  For purposes of their study, researchers Elizabeth Bradley and Lauren Taylor considered spending on “social services, like rent subsidies, employment-training programs, unemployment benefits, old-age pensions, family support and other services that can extend and improve life.”  The point being that if you can keep people in homes, without dire economic conditions, and with enough support for family members that you’re going to likely increase performance on health outcomes down stream.

We studied 10 years’ worth of data and found that if you counted the combined investment in health care and social services, the United States no longer spent the most money — far from it. In 2005, for example, the United States devoted only 29 percent of gross domestic product to health and social services combined, while countries like Sweden, France, the Netherlands, Belgium and Denmark dedicated 33 percent to 38 percent of their G.D.P. to the combination. We came in 10th.

What’s more, America is one of only three industrialized countries to spend the majority of its health and social services budget on health care itself. For every dollar we spend on health care, we spend an additional 90 cents on social services. In our peer countries, for every dollar spent on health care, an additional $2 is spent on social services. So not only are we spending less, we’re allocating our resources disproportionately on health care.

Our study found that countries with high health care spending relative to social spending had lower life expectancy and higher infant mortality than countries that favored social spending. While the stagnating life expectancy in the United States remains at 78 years, in many European countries it has leapt to well over 80 years, and several countries boast infant mortality rates approximately half of ours. In a national survey conducted by the Robert Wood Johnson Foundation, four out of five physicians agreed that unmet social needs led directly to worse health.

Among the most powerful data points in this piece:  that chronically homeless folks don’t just cost a lot of money in the health care system, they are dramatically more costly.

The Boston Health Care for the Homeless Program tracked the medical expenses of 119 chronically homeless people for several years. In one five-year period, the group accounted for 18,834 emergency room visits estimated to cost $12.7 million.

This is something to chew on.  If you want to bend the cost curve, perhaps we need to pay case workers as much as neurosurgeons.  Hmm.