US healthcare: How we apply care matters too
Over the past ten years Americans have talked ad nauseam about health care and unquestionably it has peaked again this year. Just this week, the US House has passed a modification or reform to the Affordable Care Act. While many of the details of the bill are still being flushed out, we still have much uncertainty on how any of the health care reforms in the US will really impact or reform health care. Despite it being an over a 3.2 trillion dollar expense (according to CMS in 2015), the discussion is generally limited to health coverage and costs. Even among health care professionals and those in academic circles most of the dialogue is narrowed to only a few topics. So how do we as Americans even attempt to reform this trillion dollar industry when the general public and experts in the field only discuss a fraction of the issues facing it?
Some of the challenges facing the U.S. system became more crystalized to me after completing a recent trip to Vietnam. I participated in a multi month project regarding Vietnam’s health care system. My purpose was to provide recommendations to health providers on improving collaboration and communication while also educating the patients they serve. Surprisingly the trip spotlighted the huge disparity on how we delivery health care in the United States. Despite language and cultural barriers in Vietnam, it was easier for an outsider to navigate their system than our own. The irony of this of course was not missed by me or by the folks I worked with.
Before I begin identifying specific areas to focus on, let me rebuke beforehand a few health care professionals who claim that no stone goes left unturned when it comes to improving the US system. That is simply not true. Most health care conferences, meetings, and seminars, solely focus on the areas of medical technology, pharmaceuticals, access to care, and population data, and almost never are any of these topics talked about simultaneously at the same time or venue. Silos within health care have become so vast and complicated that we have ignored connecting its components to one another.
After my trip, I noticed four areas that the US system lacks terribly that greatly affect cost and outcomes: sharing of information (to both providers and consumers), updating or modifying scope of practice for medical professionals, pricing, and where the priorities are for health care expenditures. First, the sharing of health information amongst the provider community is abysmal. We still duplicate tests and procedures from one provider to the next. “Don’t have your X-rays with you? Don’t worry, we will take a new set of images for you.” The lack of concern for duplicative diagnostic testing is pathetic and adds to the overall cost. In addition, we don’t share information to patients (or consumers) of health care. If you go online to research a car, you can locate dozens of reviews on a particular car ranging from independent safety organizations, car mechanic reviews, consumer experiences, and dealership information. From where the car is assembled to what the average mpg is, you can find out just about anything before you make one of the top 3 largest expenditures in your life. If we want healthcare to improve, we need to know who the most expensive hospital is with the highest re-admission rate, and the best MRI imaging center with the quickest times and lowest price. Consumerism in health care is not a bad thing and can help health providers improve.
How we regulate health care professionals has a cost associated to it as well. Each state decides what a nurse can and can’t do, the same with other fields like optometry, dentistry, and administration of drugs. For example, in Alaska, the state allows a Dental Health Aide Hygienist to administer a local anaesthetic because dentists are few and far between. Some states also allow an Advanced Nurse Practitioner to see certain patients instead of a primary care doctor. As medicine evolves, so should the way we allow certain medical professionals to practice it. The same goes for pharmaceutical drugs. In Vietnam, I can go to a local pharmacy talk to a local pharmacist, ask for an antibiotic for a sinus infection or a sleeping pill for insomnia, and my out of pocket is $5 or $10 US dollars. However, in the US, I am required to go to physician, pay them with insurance and a deductible (which I pay for both on average of $100 per visit), then go to a pharmacy and pay an extra $10 for a generic. The time and cost is over a 10 times more and my risks are no different.
Furthermore, we must have more transparency in pricing. Health care is the only industry where we don’t know the bill until after the procedure is complete. Again, using the car analogy, I roughly know what repair costs will be before I have the mechanic take the care apart. It’s not perfect, but I least I have a ball park figure as to what repairs will be. It makes the mechanic accountable for staying close to his quote. In health care, we truly don’t know what the actual costs are for the broken leg, using the MRI machine, or for the gall bladder surgery. Shouldn’t hospitals, especially nonprofit ones, disclose price and costs to patients?
Lastly, one cannot write a health care article without stating the obvious in order to keep certain critics at bay: Americans are getting older, sicker, and poorer. The average age of an American is 38, compared to 29 for Vietnam. Plenty of studies show that older populations use the health care system at a higher frequency. In addition, Americans numbers are increasing in expensive areas like diabetes and obesity, and smoking still hovers around 20–25%. How we allocate money to provable methods of prevention are extremely important. Too much money is spent on things that we could avert with proper education and awareness. We as patients need to be accountable as well.
There needs to be more frank discussions about responsibility and transparency, from payer to provider. One interview or article won’t solve all the issues facing the US health care system, and certainly scare tactics about coverage don’t help either. Arguably, there are sufficient resources in the system, it’s just a matter of how efficient we use them. We should look at more simple health systems to see what is done right in order to improve our own system which often appears cumbersome and disconnected.