Federal Reserve Bank of San Francisco

Community Development

Can Pay for Success Reduce Asthma Emergencies and Reset a Broken Health Care System?

Author(s): Rick Brush, Collective Health

April 2013

Community Development Investment Review

I blame Len Syme and the social epidemiologists for disrupting my otherwise steady trajectory as a high-flying health insurance executive. It was Len, the University of California Berkeley professor emeritus, who spoiled for me the simple notion that “access to high-quality, affordable care” (our industry mantra) would solve our nation’s health crisis. Medical care, it turns out, accounts for just 10 percent of what makes us healthy or sick. So what’s the other 90 percent? It’s a pretty gnarly sweater once you start unraveling it. After nearly a decade in health insurance, I left the comfy confines of my corporate office to follow a thread Len so eloquently describes as “intricately and infinitely intertwined” with our social, economic, and environmental circumstances. What matters most to health is the context in which we live our lives. This calls for a profoundly different health delivery and financing system, I’ve come to learn, with some pretty hefty obstacles in the way. But it is possible to meet these challenges. In this article, I look at a path forward for one chronic condition, childhood asthma, and the potential for spreading this approach to the broader health system.

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