Editor's Choice US Editor’s Choice

Get more for less

BMJ 2013; 347 doi: https://doi.org/10.1136/bmj.f5337 (Published 30 August 2013) Cite this as: BMJ 2013;347:f5337
  1. Edward Davies, US news and features editor
  1. edavies{at}bmj.com

Getting a bang for your buck is hardly a concept restricted to US healthcare, but in the world’s highest spending country a greater bang for those healthcare bucks is constantly top of the agenda.

Although much of the focus on achieving this is on federal health reform and the national system, several of the best examples of how this can be done are to be found at a very local level.

One such example is the Nuka system in Alaska. About as far, both physically and metaphorically, as is possible from the policy halls in Washington, DC, Alaska’s Southcentral Foundation has set up this system for native people that is leading the world.

Since a major restructure in 2000, Nuka—a native word for strong living things—has become a crucial case study in how to do healthcare better and more cheaply.

This week Bill Graves looks at what they’ve done and how they’ve done it (doi:10.1136/bmj.f5301).

The success of the system is startling: “Since Nuka was developed in the late 1990s, Southcentral Foundation has cut hospital emergency room visits by 42%, hospital days by 36%, specialty care by 58%, and routine doctor visits by 30%, all of which have cut costs.

“For Anchorage area natives during the first decade of this century, binge drinking declined by 30%, suicides fell by 66%, strokes plunged by 62%, all falling along with deaths from heart disease and cancer to about the national average. Thirty years ago, Alaska had the highest fatality rate in the nation for newborns in the first 28 days of life. As of 2011, it had moved from worst to best. Also, under Nuka, the portion of children receiving high quality care for asthma has climbed from 35% to 85% and more than 90% of infants get needed immunizations by age 2.”

Two of the ways in which they have done this stand out in particular. Integrated care and population health are buzzwords that have been overused into meaningless oblivion in policy circles, but, when translated into the day to day work of a system such of this, they make great sense.

The Nuka system will not work everywhere and will not change the world, but that’s not stopping health leaders from across the world coming to take a look.


Cite this as: BMJ 2013;347:f5337


View Abstract