{"id":1059,"date":"2026-01-08T09:27:26","date_gmt":"2026-01-08T09:27:26","guid":{"rendered":"https:\/\/blogs.bmj.com\/bmjleader\/?p=1059"},"modified":"2026-01-08T13:31:21","modified_gmt":"2026-01-08T13:31:21","slug":"the-true-cost-of-care-by-kate-b-hilton-and-carrie-colla","status":"publish","type":"post","link":"https:\/\/blogs.bmj.com\/bmjleader\/2026\/01\/08\/the-true-cost-of-care-by-kate-b-hilton-and-carrie-colla\/","title":{"rendered":"The True Cost of Care. By Kate B. Hilton and Carrie Colla"},"content":{"rendered":"<p><span style=\"font-weight: 400\">Health care needs a new way to measure success \u2013 one that values what actually produces health.<\/span><\/p>\n<p><span style=\"font-weight: 400\">For decades, financial flows \u2013 revenues, reimbursements, spending and productivity \u2013 have dominated how modern industrialized nations judge success in health care. But these measures conceal the healthcare system\u2019s most consequential losses: worsening patient outcomes and eroding trust, workforce burnout and turnover, persistent inequities, and growing climate harms. In the United States alone, when the \u201coff-balance-sheet\u201d costs are made visible, conservative estimates suggest that they total $2.05-2.27 trillion annually \u2013 roughly 42-46% of all U.S. health spending in 2023 ($4.9 trillion) (see <\/span><span style=\"font-weight: 400\">Figure 1<\/span><span style=\"font-weight: 400\">, and comparison with total spending in <\/span><span style=\"font-weight: 400\">Figure 3<\/span><span style=\"font-weight: 400\">).^1,2,3,4,5,6,7,8,9\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">This total reflects the aggregation of established estimates: waste ($906-1,114B), inequities ($547B), workforce turnover and burnout ($29-40B), and healthcare\u2019s climate externalities ($570B). These figures are conservative, exclude overlaps, and capture only direct costs \u2013 meaning the true losses are likely even higher. They must be considered when we ask whether current spending figures are \u201cworth it\u201d for the outcomes we achieve.<\/span><\/p>\n<p><b>A New Measure of Success<\/b><\/p>\n<p><span style=\"font-weight: 400\">A useful parallel comes from economics. The concept of \u201cinclusive wealth\u201d moves beyond GDP to account for natural, human, and produced capital (Dasgupta et al 2021). Applied to health care, success should be measured by whether systems are sustaining \u2013 or eroding \u2013 the assets they depend on.<\/span><\/p>\n<p><span style=\"font-weight: 400\">New metrics must reflect:<\/span><\/p>\n<ul>\n<li style=\"font-weight: 400\"><b>Patient health and trust<\/b><span style=\"font-weight: 400\"> as core assets;<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Workforce wellbeing<\/b><span style=\"font-weight: 400\"> as infrastructure;<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Equitable care<\/b><span style=\"font-weight: 400\"> as both moral and economic imperative;<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Responsible innovation<\/b><span style=\"font-weight: 400\"> grounded in evidence;<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Environmental impact <\/b><span style=\"font-weight: 400\">as a performance indicator.<\/span><\/li>\n<\/ul>\n<p><span style=\"font-weight: 400\">This reframing would expose the hidden costs of neglect and reorient leadership and investment toward sustained resilience (<\/span><span style=\"font-weight: 400\">Figures 1<\/span><span style=\"font-weight: 400\"> and <\/span><span style=\"font-weight: 400\">2<\/span><span style=\"font-weight: 400\">).<\/span><\/p>\n<p style=\"padding-left: 120px\"><b>Figure 1: The Hidden Balance Sheet of U.S. Health Care\u00a0<\/b><\/p>\n<p style=\"padding-left: 120px\"><b>Hidden costs of U.S. health care: <\/b><span style=\"font-weight: 400\">$2.05-2.27 trillion annually (adjusted to 2023 dollars) (roughly 42-46% of total U.S. health spending in 2023)\u00a0<\/span><\/p>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li><b>Systemic waste &amp; low-value care: <\/b><span style=\"font-weight: 400\">$906-1,114B\u00a0<\/span><\/li>\n<li><b>Health inequities: <\/b><span style=\"font-weight: 400\">$547B\u00a0<\/span><\/li>\n<li><b>Workforce burnout &amp; turnover: <\/b><span style=\"font-weight: 400\">$29-40B\u00a0<\/span><\/li>\n<li><b>Climate externalities: <\/b><span style=\"font-weight: 400\">$570B\u00a0<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p style=\"padding-left: 120px\"><b>Bottom line: <\/b><span style=\"font-weight: 400\">Even with conservative estimates, U.S. health care is depleting its \u201chealth\u00a0 capital\u201d \u2013 patients\u2019 outcomes and trust, workforce wellbeing, population health, and\u00a0 climate resilience \u2013 without accounting for the loss.\u00a0<\/span><\/p>\n<p style=\"padding-left: 120px\"><i><span style=\"font-weight: 400\">Note: Spending on artificial intelligence in healthcare is estimated at approximately $13\u00a0 billion in 2024, reflecting rapid market expansion. However, current evidence of net\u00a0 benefit or harm remains limited; therefore, AI-related expenditures are not included in the\u00a0 hidden total costs.<\/span><\/i><\/p>\n<p>&nbsp;<\/p>\n<p style=\"padding-left: 120px\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-1061 size-medium\" src=\"http:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/True-Costs-of-Care-Figure-2-PNG-300x194.png\" alt=\"Bar chart showing hidden costs by domain figures. Figure 2.\" width=\"300\" height=\"194\" srcset=\"https:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/True-Costs-of-Care-Figure-2-PNG-300x194.png 300w, https:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/True-Costs-of-Care-Figure-2-PNG-1024x663.png 1024w, https:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/True-Costs-of-Care-Figure-2-PNG-768x497.png 768w, https:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/True-Costs-of-Care-Figure-2-PNG-640x414.png 640w, https:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/True-Costs-of-Care-Figure-2-PNG.png 1294w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/p>\n<p style=\"padding-left: 120px\"><span style=\"font-weight: 400\">Inflation Adjusted Using Consumer Price Index \u2013 Urban Consumers to 2023 U.S. Dollars<\/span><\/p>\n<p style=\"padding-left: 120px\"><b>Notes on Calculations in Figure 2.<\/b><\/p>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">All CPI values are BLS CPI-U annual averages. Inflation base year: 2023 USD.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Waste: Shrank et al., JAMA 2019 ($760-$935B, 2019 USD).<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Inequities: LaVeist et al., JAMA 2023; racial &amp; ethnic burden $451B, 2018 USD.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Workforce RN turnover: NSI 2025; $3.9-$5.7M per hospital. Hospitals=6,120 (AHA FY2022). Back-cast to 2023USD using 2023\/2024 CPI ratio.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Workforce physician burnout: Han et al., Ann Intern Med 2019; $4.6B, 2019 USD.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Climate: 610 MtCO2e (Eckelman et al., Health Affairs 2020). SCC range $51-$190 per ton (2020$) converted to 2023 USD and multiplied by emissions.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Totals sum low and high bounds after converting each component to 2023 USD.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p>&nbsp;<\/p>\n<p><b>Where Costs Accumulate: What GDP Hides in Health Care<\/b><\/p>\n<p><span style=\"font-weight: 400\">Economists have urged governments to rethink what counts as economic success (Dasgupta, 2021). In 2021, Professor Sir Partha Dasgupta reframed prosperity by showing how gross domestic product hides depletion of natural assets, and by treating nature as free and limitless, our economic systems will ultimately erode their very foundations.\u00a0<\/span><\/p>\n<p><span style=\"font-weight: 400\">A similar reckoning is needed in U.S. health care. Including only financial measures such as total spending on health care (about 18% of the U.S. economy), many believe we are already failing to achieve outcomes worthy of this level of investment. Yet, the costs are much higher than the numbers suggest, and our spending figures hide what matters most: people\u2019s health, the workforce, social trust and environmental resilience. In effect, we are running down the resources we need to produce health \u2013 and the costs are mounting.<\/span><\/p>\n<p><span style=\"font-weight: 400\">What appears as financial growth may, in fact, be systemic depletion. Leaders who rely on narrow financial metrics risk mistaking fragility for performance \u2013 and investing in strategies that undermine long-term resilience. Only by valuing what matters to population health can the healthcare industry secure resilience, trust, and long-term prosperity.<\/span><\/p>\n<p><b>Patients: Outcomes and Trust<\/b><\/p>\n<p><span style=\"font-weight: 400\">The U.S. spends more per capita on health care than any other nation, yet outcomes lag far behind peers. Life expectancy, maternal mortality, and preventable deaths all paint a bleak picture. Meanwhile, trust in health care continues to erode, driven by misinformation, fragmented care, and persistent inequities. These losses are rarely counted as \u201ccosts,\u201d but they directly reduce health care\u2019s ability to deliver health. (<\/span><span style=\"font-weight: 400\">Figure 1<\/span><span style=\"font-weight: 400\"> summarizes how these unmeasured losses add up.)<\/span><\/p>\n<p><b>Workforce: Burnout and Turnover<\/b><\/p>\n<p><span style=\"font-weight: 400\">Economic prosperity depends on balancing demand with nature\u2019s regenerative capacity (Dasgupta, 2021). In health care, that capacity is our workforce \u2013 and we are exhausting it. Burnout, moral injury, and workload burdens are driving record turnover. Replacing a bedside nurse costs an average of $61,110; replacing a physician can range from $500,000 to over $1 million.^5,6 Hospitals lose between $3.9-$5.7 million per year due to nurse turnover (excluding agency\/travel staff), while physician burnout costs the U.S. health system about $5.48 billion each year (2023 USD).^5,6 The cost of an early retirement or a career switch out of health care is borne by those left behind \u2013 speeding the feedback loop of burnout and overwhelm, depreciating of our most critical asset: people.<\/span><\/p>\n<p><b>Disparities: Unequal Health Capital<\/b><\/p>\n<p><span style=\"font-weight: 400\">Just as ecological degradation harms the poorest, the failures of U.S. health care fall hardest on marginalized communities. Structural racism, underinvestment in primary care, and inequities in insurance perpetuate disparities that carry an annual economic burden of roughly $547 billion (2023 USD, inflation-adjusted from the original $451 billion estimate).^2,3,4 These inequities represent squandered human capital \u2013 vast pools of potential left unrealized \u2013 and a national workforce full of people who are sick is less productive.^9<\/span><\/p>\n<p><b>Technology: Promise and Peril of AI<\/b><\/p>\n<p><span style=\"font-weight: 400\">The rush to adopt artificial intelligence mirrors unsustainable subsidies in other sectors: potentially transformative, yet risky. Many tools enter practice without robust evidence or safeguards against bias. High costs and inequitable access risk widening disparities rather than closing them. Without careful governance, investments in experimental technology could consume resources better spent on proven, evidence-based care. (AI is not included in the totals shown in <\/span><span style=\"font-weight: 400\">Figure 1<\/span><span style=\"font-weight: 400\">, which reflect established estimates for other domains.)<\/span><\/p>\n<p><b>Climate: Health Systems on the Frontline<\/b><\/p>\n<p><span style=\"font-weight: 400\">Hospitals are vulnerable to floods, fires, and storms. At the same time, health care contributes nearly 9% of U.S. greenhouse gas emissions, generating an estimated 610 million metric tons of CO<\/span><span style=\"font-weight: 400\">\u2082<\/span><span style=\"font-weight: 400\">e annually.^7 Poor air quality leads to increases in asthma and other chronic conditions; health system commitments to reducing emissions are gaining traction.^10 Unless climate resilience becomes central to planning, health care will remain both a victim and a driver of crisis (see <\/span><span style=\"font-weight: 400\">Figure 2<\/span><span style=\"font-weight: 400\"> for the climate externality estimate and <\/span><span style=\"font-weight: 400\">Figure 3<\/span><span style=\"font-weight: 400\"> for scale relative to total spending).<\/span><\/p>\n<p><span style=\"font-weight: 400\">Health care is embedded within the health of patients, providers, communities and the environment. To ignore these foundations is economically reckless. It is time to expand our definitions of cost in health care and shift to measures of outcomes, workforce sustainability, equitable care and environmental stewardship. Only then will we truly see \u2013 and account for \u2013 the true cost of care.<\/span><\/p>\n<p style=\"padding-left: 120px\"><img loading=\"lazy\" decoding=\"async\" class=\"alignnone size-medium wp-image-1060\" src=\"http:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/True-Costs-of-Care-Figure-3-PNG-300x243.png\" alt=\"Stacked bar chart of hidden costs with total US health spending. Figure 3\" width=\"300\" height=\"243\" srcset=\"https:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/True-Costs-of-Care-Figure-3-PNG-300x243.png 300w, https:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/True-Costs-of-Care-Figure-3-PNG-1024x828.png 1024w, https:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/True-Costs-of-Care-Figure-3-PNG-768x621.png 768w, https:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/True-Costs-of-Care-Figure-3-PNG-640x518.png 640w, https:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/True-Costs-of-Care-Figure-3-PNG.png 1244w\" sizes=\"auto, (max-width: 300px) 100vw, 300px\" \/><\/p>\n<p style=\"padding-left: 120px\"><span style=\"font-weight: 400\">Inflation Adjusted Using Consumer Price Index \u2013 Urban Consumers to 2023 U.S. Dollars<\/span><\/p>\n<p style=\"padding-left: 120px\"><b>Notes on Calculations in Figure 3.<\/b><\/p>\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li style=\"list-style-type: none\">\n<ul>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">All CPI values are BLS CPI-U annual averages. Inflation base year: 2023 USD.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Waste: Shrank et al., JAMA 2019 ($760-$935B, 2019 USD).<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Inequities: LaVeist et al., JAMA 2023; racial &amp; ethnic burden $451B, 2018 USD.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Workforce RN turnover: NSI 2025; $3.9-$5.7M per hospital. Hospitals=6,120 (AHA FY2022). Back-cast to 2023USD using 2023\/2024 CPI ratio.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Workforce physician burnout: Han et al., Ann Intern Med 2019; $4.6B, 2019 USD.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Climate: 610 MtCO2e (Eckelman et al., Health Affairs 2020). SCC range $51-$190 per ton (2020$) converted to 2023 USD and multiplied by emissions.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Totals sum low and high bounds after converting each component to 2023 USD.<\/span><\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<p><b>Learning Points<\/b><\/p>\n<ul>\n<li style=\"font-weight: 400\"><b>Financial metrics conceal hidden losses.<\/b><span style=\"font-weight: 400\"> Like GDP in economics, revenues and reimbursements in health care disguise the erosion of outcomes, trust, and resilience.<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Hidden costs are vast.<\/b><span style=\"font-weight: 400\"> Waste, inequities, burnout, and climate externalities total <\/span><b>$2.05-2.27 trillion annually<\/b><span style=\"font-weight: 400\">, approaching half of U.S. health spending (2023).<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Workforce depletion is unsustainable.<\/b><span style=\"font-weight: 400\"> Burnout and turnover represent billions in avoidable costs and threaten system stability.<\/span><\/li>\n<li style=\"font-weight: 400\"><b>Environmental and population health are economic imperatives.<\/b><span style=\"font-weight: 400\"> Disparities and health-sector emissions undermine justice and prosperity.<\/span><\/li>\n<li style=\"font-weight: 400\"><b>New measures of success are urgent.<\/b><span style=\"font-weight: 400\"> Health care must move beyond financial growth to metrics of outcomes, workforce wellbeing, population health and climate resilience.<\/span><\/li>\n<\/ul>\n<p><b>Selected References<\/b><\/p>\n<ol>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Shrank WH, Rogstad TL, Parekh N. \u201cWaste in the US Health Care System: Estimated Costs and Potential for Savings.\u201d <\/span><i><span style=\"font-weight: 400\">JAMA<\/span><\/i><span style=\"font-weight: 400\">. 2019;322(15):1501-1509.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Waidmann TA, et al. \u201cThe Economic Burden of Racial and Ethnic Health Inequities in the United States.\u201d <\/span><i><span style=\"font-weight: 400\">Urban Institute<\/span><\/i><span style=\"font-weight: 400\">; 2009.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">LaVeist TA,\u00a0P\u00e9rez-Stable EJ,\u00a0Richard P, et al. \u201cThe Economic Burden of Racial, Ethnic, and Educational Health Inequities in the US.\u201d\u00a0<\/span><i><span style=\"font-weight: 400\">JAMA.<\/span><\/i><span style=\"font-weight: 400\">\u00a02023;329(19):1682\u20131692.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Lavizzo-Mourey R, Besser R, Williams D. \u201cUnderstanding and Mitigating Health Inequities.\u201d <\/span><i><span style=\"font-weight: 400\">N Engl J Med<\/span><\/i><span style=\"font-weight: 400\">. 2021;383:1681-1684. <\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Han S, Shanafelt TD, Sinsky CA, et al. \u201cEstimating the Attributable Cost of Physician Burnout in the United States.\u201d <\/span><i><span style=\"font-weight: 400\">Annals of Internal Medicine<\/span><\/i><span style=\"font-weight: 400\">. 2019;170(11):784-790.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">NSI Nursing Solutions. \u201c2025 NSI National Health Care Retention &amp; RN Staffing Report.\u201d <\/span><i><span style=\"font-weight: 400\">NSI Nursing Solutions, Inc.<\/span><\/i><span style=\"font-weight: 400\"> 2025.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Eckelman MJ, <\/span><span style=\"font-weight: 400\">Huang K, Lagasse R, Senay E, Dubrow R, <\/span><span style=\"font-weight: 400\">Sherman JD. \u201cHealth Care Pollution and Public Health Damage in the United States: An Update.\u201d <\/span><i><span style=\"font-weight: 400\">Health Affairs<\/span><\/i><span style=\"font-weight: 400\">. 2020 Dec;39(12):2071-2079.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Centers for Medicare &amp; Medicaid Services (CMS). \u201cNational Health Expenditure Fact Sheet, Historical NHE 2023.\u201d Baltimore, MD: <\/span><i><span style=\"font-weight: 400\">CMS<\/span><\/i><span style=\"font-weight: 400\">, 2025.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Goetzel RZ, et al.\u201cHealth, Absence, Disability, and Presenteeism Cost Estimates of Certain Physical and Mental Health Conditions Affecting U.S. Employers,\u201d <\/span><i><span style=\"font-weight: 400\">Journal of Occupational and Environmental Medicine<\/span><\/i><span style=\"font-weight: 400\"> 46 (April 2004): 398-412.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Pollack, R. \u201cAHA Statement on HHS Pledge Initiative to Mobilize Health Care Sector to Reduce Emissions.\u201d <\/span><i><span style=\"font-weight: 400\">American Hospital Association<\/span><\/i><span style=\"font-weight: 400\">. April 22, 2022.\u00a0<\/span><\/li>\n<\/ol>\n<p><b>All References<\/b><\/p>\n<ol>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Shrank WH, Rogstad TL, Parekh N. \u201cWaste in the US Health Care System: Estimated Costs and Potential for Savings.\u201d <\/span><i><span style=\"font-weight: 400\">JAMA<\/span><\/i><span style=\"font-weight: 400\">. 2019;322(15):1501-1509. doi:10.1001\/jama.2019.13978. Available at: <\/span><a href=\"https:\/\/jamanetwork.com\/journals\/jama\/article-abstract\/2752664\"><span style=\"font-weight: 400\">JAMA<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Waidmann TA, et al. \u201cThe Economic Burden of Racial and Ethnic Health Inequities in the United States.\u201d <\/span><i><span style=\"font-weight: 400\">Urban Institute<\/span><\/i><span style=\"font-weight: 400\">; 2009. Available at: <\/span><a href=\"https:\/\/www.urban.org\/sites\/default\/files\/publication\/30666\/411962-Estimating-the-Cost-of-Racial-and-Ethnic-Health-Disparities.PDF\"><span style=\"font-weight: 400\">Urban Institute<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">LaVeist TA,\u00a0P\u00e9rez-Stable EJ,\u00a0Richard P, et al. \u201cThe Economic Burden of Racial, Ethnic, and Educational Health Inequities in the US.\u201d\u00a0<\/span><i><span style=\"font-weight: 400\">JAMA.<\/span><\/i><span style=\"font-weight: 400\">\u00a02023;329(19):1682\u20131692. doi:10.1001\/jama.2023.5965. <\/span><span style=\"font-weight: 400\">Available at: <\/span><a href=\"https:\/\/jamanetwork.com\/journals\/jama\/article-abstract\/2804818\"><span style=\"font-weight: 400\">JAMA<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Lavizzo-Mourey R, Besser R, Williams D. \u201cUnderstanding and Mitigating Health Inequities.\u201d <\/span><i><span style=\"font-weight: 400\">N Engl J Med<\/span><\/i><span style=\"font-weight: 400\">. 2021;383:1681-1684. doi:10.1056\/NEJMp2008628. Available at: <\/span><a href=\"https:\/\/www.nejm.org\/doi\/full\/10.1056\/NEJMp2008628\"><span style=\"font-weight: 400\">NEJM<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Han S, Shanafelt TD, Sinsky CA, et al. \u201cEstimating the Attributable Cost of Physician Burnout in the United States.\u201d <\/span><i><span style=\"font-weight: 400\">Annals of Internal Medicine<\/span><\/i><span style=\"font-weight: 400\">. 2019;170(11):784-790. doi:10.7326\/M18-1422. <\/span><span style=\"font-weight: 400\">Epub 2019 May 28. PMID: 31132791.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">American Medical Association (AMA). \u201cCost analysis examines primary care physician turnover due to burnout.\u201d 2022. Available at: <\/span><a href=\"https:\/\/www.ama-assn.org\/press-center\/ama-press-releases\/ama-cost-analysis-examines-primary-care-physician-turnover#:~:text=The%20new%20analysis%20found%20that,27%25)%20attributable%20to%20burnout.\"><span style=\"font-weight: 400\">AMA Press Release<\/span><\/a><span style=\"font-weight: 400\">. <\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">NSI Nursing Solutions. \u201c2025 NSI National Health Care Retention &amp; RN Staffing Report.\u201d <\/span><i><span style=\"font-weight: 400\">NSI Nursing Solutions, Inc.<\/span><\/i><span style=\"font-weight: 400\"> 2025. Available at: <\/span><a href=\"https:\/\/www.nsinursingsolutions.com\/documents\/library\/nsi_national_health_care_retention_report.pdf\"><span style=\"font-weight: 400\">NSI Report PDF<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Jeppson J, Anderson J. \u201cKLAS Research Collaborative: Clinician Turnover 2024 Report.\u201d <\/span><i><span style=\"font-weight: 400\">KLAS Research<\/span><\/i><span style=\"font-weight: 400\">, 2024. Available at: <\/span><a href=\"https:\/\/klasresearch.com\/archcollaborative\/report\/clinician-turnover-2024\/621\"><span style=\"font-weight: 400\">KLAS Research<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Eckelman MJ, <\/span><span style=\"font-weight: 400\">Huang K, Lagasse R, Senay E, Dubrow R, <\/span><span style=\"font-weight: 400\">Sherman JD. \u201cHealth Care Pollution and Public Health Damage in the United States: An Update.\u201d <\/span><i><span style=\"font-weight: 400\">Health Affairs<\/span><\/i><span style=\"font-weight: 400\">. 2020 Dec;39(12):2071-2079. doi:<\/span><span style=\"font-weight: 400\"> 10.1377\/hlthaff.2020.01247<\/span><span style=\"font-weight: 400\">. Available at: <\/span><a href=\"https:\/\/www.healthaffairs.org\/doi\/10.1377\/hlthaff.2020.01247\"><span style=\"font-weight: 400\">Health Affairs<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Karliner J, Slotterback S, Boyd R, Ashby B, Steele K. \u201cHealth Care\u2019s Climate Footprint Report.\u201d <\/span><i><span style=\"font-weight: 400\">Health Care Without Harm<\/span><\/i><span style=\"font-weight: 400\">. 2019. Available at: <\/span><a href=\"https:\/\/global.noharm.org\/sites\/default\/files\/documents-files\/5961\/HealthCaresClimateFootprint_092319.pdf\"><span style=\"font-weight: 400\">Health Care Without Harm<\/span><\/a><span style=\"font-weight: 400\">. <\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">U.S. Environmental Protection Agency (EPA), National Center for Environmental Economics Office of Policy, Climate Change Division Office of Air and Radiation. \u201cReport on the Social Cost of Greenhouse Gases: Estimates Incorporating Recent Scientific Advances.\u201d Washington, DC: <\/span><i><span style=\"font-weight: 400\">EPA<\/span><\/i><span style=\"font-weight: 400\">, 2023. Available at: <\/span><a href=\"https:\/\/www.epa.gov\/system\/files\/documents\/2023-12\/epa_scghg_2023_report_final.pdf\"><span style=\"font-weight: 400\">Environmental Protection Agency<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Seervai S, Gustafsson L, Abrams M. \u201cHow the U.S. Health Care System Contributes to Climate Change.\u201d <\/span><i><span style=\"font-weight: 400\">Commonwealth Fund<\/span><\/i><span style=\"font-weight: 400\">, 2022. Available at: <\/span><a href=\"https:\/\/www.commonwealthfund.org\/publications\/explainer\/2022\/apr\/how-us-health-care-system-contributes-climate-change\"><span style=\"font-weight: 400\">Commonwealth Fund<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Nguyen T. \u201cDecoding the Cost of Implementing AI in Healthcare.\u201d Blog article, <\/span><i><span style=\"font-weight: 400\">NeuronD<\/span><\/i><span style=\"font-weight: 400\">, 2023. Available at: <\/span><a href=\"https:\/\/www.neurond.com\/blog\/cost-of-implementing-ai-in-healthcare\"><span style=\"font-weight: 400\">NeuronD<\/span><\/a><span style=\"font-weight: 400\">. <\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Kharychkova, A. \u201cThe Real Cost of Implementing AI in Healthcare.\u201d Blog article, <\/span><i><span style=\"font-weight: 400\">Orangesoft<\/span><\/i><span style=\"font-weight: 400\">, 2025. Available at: <\/span><a href=\"https:\/\/orangesoft.co\/blog\/the-real-cost-of-implementing-ai-in-healthcare\"><span style=\"font-weight: 400\">Orangesoft<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Centers for Medicare &amp; Medicaid Services (CMS). \u201cNational Health Expenditure Fact Sheet, Historical NHE 2023.\u201d Baltimore, MD: <\/span><i><span style=\"font-weight: 400\">CMS<\/span><\/i><span style=\"font-weight: 400\">, 2025. Available at: <\/span><a href=\"https:\/\/www.cms.gov\/data-research\/statistics-trends-and-reports\/national-health-expenditure-data\/nhe-fact-sheet\"><span style=\"font-weight: 400\">CMS.gov<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Goetzel RZ, et al.\u201cHealth, Absence, Disability, and Presenteeism Cost Estimates of Certain Physical and Mental Health Conditions Affecting U.S. Employers,\u201d <\/span><i><span style=\"font-weight: 400\">Journal of Occupational and Environmental Medicine<\/span><\/i><span style=\"font-weight: 400\"> 46 (April 2004): 398-412. Available at: <\/span><a href=\"https:\/\/www.waterboards.ca.gov\/waterrights\/water_issues\/programs\/bay_delta\/california_waterfix\/exhibits\/docs\/LAND\/part2\/land_160.pdf\"><span style=\"font-weight: 400\">California State Water Resources Control Board<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Pollack, R. \u201cAHA Statement on HHS Pledge Initiative to Mobilize Health Care Sector to Reduce Emissions.\u201d <\/span><i><span style=\"font-weight: 400\">American Hospital Association<\/span><\/i><span style=\"font-weight: 400\">. April 22, 2022.\u00a0<\/span><\/li>\n<li style=\"font-weight: 400\"><span style=\"font-weight: 400\">Dasgupta P. \u201cThe Economics of Biodiversity: The Dasgupta Review.\u201d London: HM Treasury, 2021. Available at: <\/span><a href=\"https:\/\/assets.publishing.service.gov.uk\/media\/602e92b2e90e07660f807b47\/The_Economics_of_Biodiversity_The_Dasgupta_Review_Full_Report.pdf\"><span style=\"font-weight: 400\">www.gov.uk\/official-documents<\/span><\/a><span style=\"font-weight: 400\">.<\/span><\/li>\n<\/ol>\n<p><b>Authors<\/b><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-1055 size-thumbnail\" src=\"http:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/Kate-Hilton-150x150.jpeg\" alt=\"Photo of Kate Hilton.\" width=\"150\" height=\"150\" srcset=\"https:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/Kate-Hilton-150x150.jpeg 150w, https:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/Kate-Hilton-300x300.jpeg 300w, https:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/Kate-Hilton-1024x1024.jpeg 1024w, https:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/Kate-Hilton-768x768.jpeg 768w, https:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/Kate-Hilton-1536x1536.jpeg 1536w, https:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/Kate-Hilton-2048x2048.jpeg 2048w, https:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/Kate-Hilton-640x640.jpeg 640w, https:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/Kate-Hilton-250x250.jpeg 250w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/p>\n<p><b>Kate B. Hilton, JD, MTS<\/b><\/p>\n<p><span style=\"font-weight: 400\">Kate works at the intersection of health system leadership, workforce sustainability, and equity as a Co-Founder and Principal of Innovation Capital, a healthcare and social impact firm committed to building human and social capital for innovation at scale.<\/span><\/p>\n<p><img loading=\"lazy\" decoding=\"async\" class=\"alignnone wp-image-1056 size-thumbnail\" src=\"http:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/Carrie-Colla-150x150.jpg\" alt=\"Photo of Carrie Colla.\" width=\"150\" height=\"150\" srcset=\"https:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/Carrie-Colla-150x150.jpg 150w, https:\/\/blogs.bmj.com\/bmjleader\/files\/2026\/01\/Carrie-Colla-250x250.jpg 250w\" sizes=\"auto, (max-width: 150px) 100vw, 150px\" \/><\/p>\n<p><b>Carrie Colla, PhD<\/b><\/p>\n<p><span style=\"font-weight: 400\">Carrie is a health economist and professor whose research focuses on health care delivery reform and system performance at Dartmouth College and The Dartmouth Institute for Health Policy and Clinical Practice at the Geisel School of Medicine.<\/span><\/p>\n<p><b>Declaration of Interests<\/b><\/p>\n<p><span style=\"font-weight: 400\">We have read and understood the BMJ Group policy on declaration of interests and declare the following interests: none.<\/span><\/p>\n","protected":false},"excerpt":{"rendered":"<p>Health care needs a new way to measure success \u2013 one that values what actually produces health. For decades, financial flows \u2013 revenues, reimbursements, spending and productivity \u2013 have dominated how modern industrialized nations judge success in health care. But these measures conceal the healthcare system\u2019s most consequential losses: worsening patient outcomes and eroding trust, [&#8230;]<\/p>\n<p><a class=\"btn btn-secondary understrap-read-more-link\" href=\"https:\/\/blogs.bmj.com\/bmjleader\/2026\/01\/08\/the-true-cost-of-care-by-kate-b-hilton-and-carrie-colla\/\">Read More&#8230;<\/a><\/p>\n","protected":false},"author":525,"featured_media":0,"comment_status":"open","ping_status":"open","sticky":false,"template":"","format":"standard","meta":{"footnotes":""},"categories":[1],"tags":[],"class_list":["post-1059","post","type-post","status-publish","format-standard","hentry","category-uncategorized"],"_links":{"self":[{"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/posts\/1059","targetHints":{"allow":["GET"]}}],"collection":[{"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/users\/525"}],"replies":[{"embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/comments?post=1059"}],"version-history":[{"count":0,"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/posts\/1059\/revisions"}],"wp:attachment":[{"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/media?parent=1059"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/categories?post=1059"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/blogs.bmj.com\/bmjleader\/wp-json\/wp\/v2\/tags?post=1059"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}