The collaborative is exploring the needed analysis and work for furthering the second part of Recommendation 1 of the 2012 Institute of Medicine report For the Public's Health: Investing in a Healthier Future, which calls for a specific per capita health expenditure target for the nation.

In the 2012 report, the authoring committee recommended that "[t]he Secretary of the Department of Health and Human Services should adopt an interim explicit life expectancy target, establish data systems for a permanent health-adjusted life expectancy target, and establish a specific per capita health expenditure target to be achieved by 2030. Reaching these targets should engage all health system stakeholders in actions intended to achieve parity with averages among comparable nations on healthy life expectancy and per capita health expenditure.”

The report continues: “To address the lackluster health outcomes and unsustainable health care expenditures of the United States, a critical first step is to focus national efforts by setting a national target for health system performance on two key measures: longevity and per capita health spending. Comparing life expectancy and health spending can help in assessing value realized for money; in this analysis, U.S. performance is disappointing. Although U.S. spending on health goes far beyond the threshold of diminishing returns, life expectancy and other key measures of health status lag behind those of other high-income nations (Darzi et al., 2011; OECD, 2010b). Excessive spending on medical care also presents opportunity costs—less money remains for investment in other socially important activities, such as education. Bringing health expenditures more in line with other wealthy nations will free up resources that can support other U.S. objectives that improve not only the health of Americans, but their quality of life.

An analysis has been conducted on the life expectancy component of the recommendation (see Kindig et al., 2017). The collaborative's focus will be facilitating a dialogue about and an analysis ot the health expenditure component of the recommendation.

Members of the collaborative have contributed to a special section published in the American Journal of Public Health (December 2020; see Wasteful Medical Care Spending section), and is intended to further the conversation about this important topic.

Following the Roundtable on Population Health Improvement March 2021 workshop “Health Care Expenditures: Addressing the Opportunity Cost for Population Health,” members of the collaborative (Hughes-Cromwick, Kindig, Magnan, Gourevitch, Teutsch) authored a Health Affairs blog “The Reallocationists Versus the Direct Allocationists” which discusses investment strategies to advance population health and equity.

Members of the collaborative (Kindig, D. and Magnan, S.) authored a 2022 podcast series: Population Health - The Unfinished Journey highlighting Kindig’s career, for the Interdisciplinary Association for Population Health Science (IAPHS). Episode # 6 “It’s All About the Money” discusses the challenge of finding resources for population health, including the idea of reallocating funds from ineffective or wasteful health care.

**Any activities and products associated with the collaborative do not necessarily represent the views of any one organization, the Roundtable, or the National Academies, and have not been subjected to the review procedures of, nor are they reports, products, or activities of the National Academies.