How Partnerships and Collaborations Can Improve Healthcare Access
The Institute of Medicine defines access to healthcare as having the timely use of personal health services to achieve the best health outcomes. Another definition, from an article on the International Journal for Equity in Health, highlights healthcare access as the opportunity or ease with which communities are able to use health services.
In both of these definitions, access is basically the bridge that connects two entities–the individual who needs healthcare and the system or site that provides it.
While the definition sounds simple enough, healthcare access is a complex issue. For example, while the U.S. has been ranked first by the World Health Organization (WHO) as the nation with the highest total annual spending per person on health (US$ 8,362), it doesn’t necessarily translate to a timely or easy access to health services. The WHO, in its assessment of 191 countries’ health systems, ranked the U.S. a mere thirty seventh.
Identifying why the U.S. is in such a predicament involves taking a look at all the stakeholders in the health care system and how their values and operation impact access. An overview of the overall structures, which includes government policies or regulations, is also needed in order to complete the picture.
First, we take a look at the primary players in the healthcare system — the physicians and healthcare professionals. The traditional physician-centered model is still being practiced today. It needs to evolve into one that is patient-centered. The key difference between those two models is that in a physician-centered model, doctors and healthcare professionals act independently. The patient-centered model, on the other hand, will have multiple physicians and health workers working together to deliver the best health outcome for the patient.
Physicians Need to Collaborate
Charles P. Vega and Amy Bernard wrote an article titled Inter-professional Collaboration (IPC) to Improve Health Care: An Introduction. Here, they enumerate the aims of IPC — from reducing healthcare cost to improving the general health of the nation, and individually for the patients, better experience and satisfaction.
These authors contend that when the health professionals work collaboratively with mutual respect and understanding, the timeliness or ease of access to healthcare is considerably made more efficient.
Next, we will explore the connection between access to healthcare and insurance. Many Americans have health insurance coverage. This is their main access to getting healthcare services. Whether it’s a private or public plan, individuals must have one–sometimes both, depending on coverage. When it comes to health, however, “many” is not enough.
The Center for Disease Control’s health insurance coverage reports that as of 2016, there are 28.2 million people under age 65 that are uninsured. Without health insurance, people will face a great barrier to accessing medical services. This is because the law does not require health providers to provide medical services to people who are uninsured except in emergency cases.
Although the Affordable Care Act has enabled more people to get health coverage through a government-subsidized plan, some people don’t meet the criteria or still consider the cost too high or unaffordable.
The National Center for Biotechnology Information (NCBI) has a book on its website called The Future of the Public’s Health in the 21st Century. In it, they discussed the many complications regarding health insurance in the U.S. While the authors did not discuss specific solutions about the topic, they made a strong stand on the need for to guarantee insurance coverage for 100% of the population in the country. They also pointed out that the federal government should be the key driver in a national effort to find solutions and other options to achieve stable health coverage for all.
Here we can see that although the government needs to have the initiative, it also has to engage its counterpart in the private sector concerning healthcare.
Alignment is key, according to Mark McClellan in Improving Health Care Quality: The Path Forward.” First off, the public-private partnership needs to have the same goals and objectives. Is the end goal better health outcome for the patient or to get them to use more services? The current fee-for-service mode of payment in health plans seems to end with the latter. The author states that a payment reform will allow improved health care with a lower cost.
After instituting payment reforms, the public and private sectors need to collaborate to implement outcome-based quality measures, leveraging technology that makes it easier and more efficient for healthcare providers to improve care and for patients to receive care. An example of this is utilizing electronic data systems that pave the way for the timely delivery of medical services.
In the Journal of Inter-professional Education & Practice, Hardin, Kilian and Spykerman propose that competing health systems can collaborate, especially if the objective is to improve health outcomes and reduce health care costs. Their paper on inter-professional collaboration between health care systems to improve health care outcomes and reduce costs describes the high-need, high-frequency patients who over-utilize medical care services. We can be reminded that this is a result of the payment model of fee-for-service in health plans.
Their paper was based on a case study of how two competing health care systems collaborated where physicians and health care staff had the same mission instead of having fragmented views and information of the needs of a patient. We can relate this again to another concept described earlier, which calls for a patient-centered model of health care delivery.
Through a team-based culture and the sharing resources and infrastructure, the two competing health systems were able to achieve success in patient outcomes and reduced costs. The paper also provides guidelines on how to go about an inter-professional collaborative framework. It also enumerates the authors’ lessons learned, and challenges to this kind of framework.
This type of framework — of competitors turned into collaborators — will have a better chance of success if there were some of kind of financial incentives that reward such partnership. This is definitely an alternative model to the highly competitive — and thus fragmented — system that healthcare providers are in now.
Collaborative Healthcare System
What we may imagine as a complete healthcare system acting as a whole is not necessarily true. This is another factor affecting access to healthcare in the U.S. First, there is a divide between the public health system and private health system and within each sector, further fragmentation and disconnect.
The reality is that the system is composed of complex networks of individuals, groups of individuals and organizations. that play critical roles in the nation’s health.
The others contend that when all actors in the healthcare system are encouraged to assess their own roles and responsibilities carefully then collaborate, access to healthcare would improve as well as the overall health of the nation.
BSR, a global nonprofit organization that aims for sustainability and has more than two hundred member companies and partners, produced a study on The Guiding Principles on Access to Healthcare (GPAH). Indeed, collaboration came out as the first guiding principle for better healthcare, not just in the U.S. but anywhere in the world.
According to this study, expanding access to healthcare is such a complex endeavor that it really does require the participation and partnership of everyone involved. Access to healthcare is such a complex challenge on so many levels. It requires so many resources people-wise, infrastructure-wise, and tool-wise, that the solution simply could not come from any single stakeholder.
US Healthcare is too Expensive
Interestingly, all these partnerships and collaborations, when done on all levels and across the spectrum of healthcare system players, would result in reduced healthcare cost. Earlier, we cited the disproportionate government spending on healthcare versus access to it. There are millions of Americans who are uninsured. What are their reasons? There are two: unemployment and cost.
Williams of Investopedia wrote that the fact is that healthcare in the U.S. is expensive — even with insurance. But he proceeded that to have one is still better than foregoing it for three reasons: it’s important to seek medical help; it may help in reducing medical bills; and the uninsured will have to face a tax penalty.
But why is healthcare expensive in the U.S.?
The Atlantic’s article Why Is American Health Care So Ridiculously Expensive? compared healthcare costs among seven different countries in order to put into perspective how grave the problem of cost in the U.S. is. The article illustrated the average cost of office visit for seven countries. The least expensive was Argentina at $10 and the highest was the U.S. with a whopping $176. The median cost is $30, which can be found in France and Canada.
The article asserts that there are basically two reasons why the U.S. healthcare cost is exorbitant. First, the U.S. government doesn’t manage prices like the other countries do, and second, the for-profit system we have creates huge additional costs.
This administrative cost reason is also cited by Harvard economist David Cutler who says that about a quarter of healthcare cost is associated with administration. This figure is also far higher than any other country.
As an example, Cutler brought up the situation at Duke University Hospital, which has 900 beds and 1,300 billing clerks. Because insurers have varying requirements, those billing specialists are needed just to determine how to bill. This situation could be eliminated with a single payer system such as the system they have in Canada.
A CBS article Why is health care so expensive in the first place? explores this cost problem further by stating that in the U.S. healthcare system, there is a disconnect between the consumer and the price tag. The writer, Watson, explains that typically when consumers want to purchase something or get a service, they know the cost up front. But this is not the case in the U.S. healthcare system. The actual cost of the service isn’t the fee that is reflected on the final cost of the tab because the insurance companies are negotiating the price and procedures with the provider until there is mutual agreement. It also takes weeks or months to arrive at a final cost.
Collaboration is Critical
From these sets of problems that hinder healthcare access, we could then point out that collaboration is critical. The government can collaborate with the private sector to negotiate prices, such as bringing the cost of drugs down. The high cost of administration can be resolved through inter-organizational collaboration such as insurance providers and even hospitals.
In conclusion, we could see that health is shaped by many factors and that the healthcare system that safeguards the health of its nation is made up of multiple and diverse stakeholders, too. Therefore, the challenges to bringing more access to healthcare in the U.S. come from multiple sides as well. The solutions or answers could be rounded up into single ideas but to make them work, collaboration is critical throughout the many individuals and groups that make up the system. The concept of collaboration, introduced throughout this post, means the joining of hands to bring about health improvements.
Individual citizens, government and non-government organizations, health care providers, businesses, and even the academic institutions, media and local communities all have a stake and a role in access to healthcare. To move forward, the best way is to work effectively together to allow the best possible health outcome for the country and at the lowest possible cost.
Your support is a major key in making access to healthcare in the U.S. more timely, easier, and a reality for all. To help out, visit http://www.borderlesscharity.org/
Agency for Healthcare Research and Quality, Rockville, MD. “Chapter 9 Access to Healthcare.”
Brink, Susan. “What Country Spends The Most (And Least) On Health Care Per Person?”
BSR.”Guiding Principles on Access to Healthcare A Project of the BSR Healthcare Working
Group.” Retrieved from
CDC. “Health Insurance Coverage.” Retrieved from https://www.cdc.gov/nchs/fastats/health-
Institute of Medicine (US) Committee. “The Future of the Public’s Health in the 21st Century.”
Retrieved from https://www.ncbi.nlm.nih.gov/books/NBK221239/
Hardin, Laura; Kilian, Adam. “Competing health care systems and complex patients: An inter-
professional collaboration to improve outcomes and reduce health care costs.”
Levesque, John, Harris, Mark. Russell, Grant. “Patient-centered access to health care:
conceptualizing access at the interface of health systems and populations.” Retrieved
Porter, Michael. Lee, Thomas. “The Strategy That Will Fix Health Care.” Retrieved fromhttps://hbr.org/2013/10/the-strategy-that-will-fix-health-care
Vega, Charles; Bernard, Amy. “Interprofessional Collaboration to Improve Health Care: An Introduction” Retrieved from http://www.medscape.org/viewarticle/857823
Watson, Kathryn. “Why is health care so expensive in the first place?” Retrieved from https://www.cbsnews.com/news/why-is-health-care-so-expensive-in-the-first-place/
Williams, Terri. “Don’t Have Health Insurance? What’s the Worst That Could Happen?” Retrieved fromhttp://www.investopedia.com/articles/personal-finance/120815/dont-have-health-insurance-whats-worst-could-happen.asp
World Health Organization. “Spending on health: A global overview”. Retrieved fromhttp://www.who.int/mediacentre/factsheets/fs319/en/