To suggest patients can influence the machine that drives modern healthcare is naïve and indicative of a flawed understanding of the realities of the industry. It is nothing more than pandering to the cash cows of the industry – you and I.

It is not merely the patients who are powerless cogs in the machinations of healthcare. Their care providers suffer a similar fate. Caregivers are not responsible for the systematic erosion of patient centered medicine, they too are victims. Focusing on relationships between provider and patient is therefore a wholly fruitless endeavor.

Systemic remedies are required

As an analogy, consider if you will, the provider and the patient as cellmates in a high security prison constructed and manned by pharma, insurers and their intermediaries. No amount of debate and planning between the two cellmates is going to result in their release or an improvement in their living conditions. Their only hope lies in reprieve and relying on the humanity of their jailers. If it is lacking, the pair are doomed.

Call me cynical (guilty as charged) but I cannot envision a world in which healthcare companies suddenly decide to eschew profitability for the benefit of their customers. If anything, with every passing decade, rampant capitalistic profiteering will likely worsen the lot of patients and providers, as more intermediaries emerge in the ever growing chain of healthcare and market share declines with negative population growth.

In short, our current health system globally, warped over decades from a humanity based, service industry into the profit based system of exploitation we now deal with, is as good as it gets for you and I. It cannot and will not change.

Appeasing the masses

No one likes to feel they are trapped in a system over which they have little or no control. As the healthcare system evolves and refines itself, incremental changes will center care on establishing dependency (treatment, not cure) and further isolating the farmers (providers) and their flocks (you and I) into managed farming units focused on maximizing revenues.

If you’ve seen intensive chicken farming, you get the idea.

All the signs are there and have been for the last two decades, but like all unpleasant realities, we simply turn a blind eye, as we understand on an instinctive level that we are powerless to affect change. And yet, we continue to posture, we continue to whistle into the wind. All to no effect.

While it is true that patient advocacy groups do occasionally secure small victories, these victories inevitably come at a price, usually exacted on services or pricing in a fashion so subtle that the further erosion of control goes unnoticed.

Patient activism is even encouraged by the industry to pacify the masses. The industry will go as far as sponsoring and participating in many of the patient advocacy groups that proliferate the healthcare market. Appearances matter, results however, cost extra and never at the expense of the bottom line or without a quid pro quo.

Escaping Alcatraz

So what choice then, for patient and provider, caught up in the gears of a machine intent on using them for the pursuit of profits? It is too late to walk any of this back and it cannot be undone. We lack the social backbone to address it and those who can address it lack any form of incentive that supersedes profit.

How do we return healthcare to its former heady days of doctors serving their patients, of ethical medicine, of deep bonds of trust and respect between both patient and provider. How do we ensure that future generations can benefit from technology and medical advances to improve their health, rather than being cycled into a chain of dependency, for those fortunate enough to afford anything approximating to care.

If we cannot change the existing system, the unpleasant alternative is to part ways with it. To strike out into the medical wilderness, forgoing healthcare insurers, pharma and the wretched leeches that inhabit the spaces between. To separate, permanently, the ties that bind both patient and provider to flawed systems that perpetuate abhorent levels of care.

I firmly believe this to be our only option if we are to ensure fair and free access to healing for future generations.

How this future would look and what it would encompass for doctors and patients remains to be seen, but the break needs to be made, before the gates shut for good on the flock.

The post Patient Engagement is a Pointless Pursuit appeared first on Medika Life.

In my earlier posts in this series, I have written primarily from the perspective of what primary care physicians can do to improve their patients’ health and reduce total costs of care. Concurrently, they can reclaim their right to practice in a non-frustrating environment with a limited number of daily patient visits. Torinus approaches improving health care from the perspective of a business leader faced with rising health care costs. Here I will quote and paraphrase from Torinus’ book and, since I basically agree with his recommendations, will amplify with some of my own thoughts.

He argues that company CEOs must make health care a strategic priority since it is one of the top three costs for any company. In addition, healthcare costs can make the company noncompetitive if not managed aggressively. However, strategic priority to him also means it is essential for the company to attend proactively to the health and wellness of its employees, not just be the provider of an insurance plan.

CEOs need to consider the long term for their companies and employees. The company and the employee together spend about $16,000 per year for a family for insurance as of his 2014 book publication, obviously much greater than that today! Using his $16,000 estimate, an employee who works for a company for 25–40 years represents an insurance expenditure over a lifetime career that could be as much as $400,000 to $640,000 in 2014 dollars. This drives home the point that it only makes sense to have a long-term view of employee health, beginning with an aggressive approach to maintain wellness, actively reduce risk factors and manage disease as it occurs.

Some repetition here is worthwhile. Don’t just focus on treating disease but prevent disease and maintain wellness. Of course, that will cost some money now, but the end result will be a substantial decrease in total costs over the years. And, don’t just cover disease care but arrange for each employee and family member to have outstanding primary care to avoid unnecessary excessive specialty care.

He observes that the current health care system focuses on specialty care, whereas it needs to focus on the care recipient with high-quality primary care — the patient/consumer/employee. But to be effective, the patient/consumer/employee needs to be engaged. Instead, the current healthcare system disengages the patient — it removes responsibility because the patient is not the doctor’s customer.

In his company, expenses were rising to double digits by 2003, but with their new plan in place, it dropped to 2% or less per year.

Torinus’ “prescription” for all companies (and what his company initiated beginning in 2004) follows:

First, every company, including small companies, should self-insure with an added stop-loss catastrophic policy.

Second, employees should be offered only a consumer-directed healthcare policy (CDHP), in essence, a moderately high deductible plan (often about $2500) with either an associated health savings account (HSA) or a health-related account (HRA.) The company should prefund the account with an amount (often about $1500 or more) that the individual can use for any health care needs with the assumption that since it is now the individual’s money, he or she will spend it more wisely — employee/patient engagement.

Third, the company should insist that each provider have price transparency. Since that’s often difficult to obtain, Serigraph uses various companies like Alithias Inc to provide that for them so that they can compare one provider to another. For example, they determine the price of the all-inclusive (gastroenterologist, anesthesiologist, and facility fee) along with quality data of colonoscopies at the nearest five centers and then rank them. The employee or family member who needs the colonoscopy is told that, for example, the company sees it as appropriate preventive care and so will cover the cost, in this case up to $1,500. [His book appeared before the ACA became law, so the insurance component would cover colonoscopy now, but the principle is still valid.] This is an amount that will pay for, say, four of the five local centers, but if he or she selects a provider that charges more, they are on the hook for the remainder.

Fourth, if the company is large enough, it should provide an on-site primary care clinic at no cost to the individual. For example, at Serigraph, the clinic includes a concierge-type physician (meaning that the physician is salaried, has a low number of patients under care, and gives ample time and energy to each employee/family member patient, consistent with some of my previous posts) plus a nurse practitioner, a health coach, a dietician, and a chiropractor. On the other hand, if the company is too small to justify a full-fledged clinic, then the company can pay the retainer for a nearby direct primary care/membership/concierge physician who works with others, such as a health coach.

Fifth, the clinic, with particular attention by the health coach, gives all employees a health risk assessment annually and then works one-on-one with each employee (and family member) at no cost to maintain wellness and health, including the use of behavioral change programs around diet, nutrition, exercise, stress management, and smoking cessation.

Sixth, the clinic staff gives very intense management of chronic diseases and coordination of specialist visits when needed. (See my earlier article on care coordination by the PCP)

Seventh, Serigraph uses what Torinus calls Centers of Value for procedures beyond those that the primary care physician does. These are doctors/institutions that have outstanding quality records yet a competitive price for, say, a knee replacement. Serigraph gives their employees $2,000 toward the deductible or covers the deductible for the surgery when they use these Centers of Value.

Seventh, his company gives (and he recommends others do likewise) generic drugs for free, and all of the above prevention and wellness programs are supplied free of charge. Finally, the company makes free counseling available for developing advanced directives, and if an individual requires end-of-life care, hospice is available free of charge.

I notice that his company spends considerably on extensive/comprehensive primary care, including wellness maintenance, proactive prevention, behavioral health, and chronic care management. In return, the company is rewarded in return with lower total costs and healthier workers.

Given that healthcare has become a company strategic priority, then it needs to be managed, and that requires data. Hence, he urges all companies to develop health-related management dashboards, including both a financial dashboard (how much is the company spending) and a health dashboard (how many individuals in the company have uncontrolled blood pressure, uncontrolled asthma, uncontrolled cholesterol, have not had appropriate mammography or colonoscopy, etc. — all information collected from the clinic in an unidentified manner to protect individual privacy).

These approaches are based on fundamental principles, including individual responsibility; marketplace discipline — installing consumerism, steering business to the best quality and price (“do good work and you get our business”); proactive care — maintaining employees’ health and wellness and give extensive care to those with chronic illnesses; and sound management — putting those who pay, i.e., the employer and the employee, in charge.

Torinus suggests that there are multiple rewards for following this basic approach (I added number 2 since he implied but did not write it.)

1) The reward for business is a healthier workforce and more affordable healthcare expenditures.

2) The reward for individuals is more health and wellness, less illness, and fewer dollars spent.

3) The reward for high-value providers is more business.

4) The reward for entrepreneurs comes if they innovate with better care provided at a lower cost

5) There could be a reward for taxpayers — if governments (federal, state, and local) were to utilize these approaches.

Sound advice? I certainly think so.

The post A Business Approach To Reducing Healthcare Costs appeared first on Medika Life.

“It is all about vigilance and caring. We aim to put the caring back into healthcare, and we are serious about that. Our standards are not how many patients you saw today but how much quality you dispensed today,” Dr. Greg Foti told me about the comprehensive care center, AbsoluteCare, where he works in downtown Baltimore, MD.

Individuals with multiple chronic illnesses compounded by socioeconomic issues are perhaps the most difficult to treat, and the annual expenses can be exceptionally high. Success with these patients would be a story worth telling. Here it is.

Individual doctors and doctor groups have embraced the direct primary care approach with either a fee per visit (direct pay) or a fee per month or year (membership, retainer, and concierge). Mostly, they convert an ongoing practice of 2500–3000+ plus patients to a new model that encompasses about 500 patients. Their patient group usually spans a wide range of ages and the spectrum of some with serious chronic illnesses to those who are basically healthy. I wrote earlier in this series about the advantage of an all- gerontology practice that maintains a patient panel per PCP of about 400.

But what about a panel of patients that all have serious illnesses, who are socio-economically disadvantaged and cannot afford to pay a membership? A number of companies are addressing this need with a focus on the medically most needy; here is an example.

An infectious disease practice in Atlanta initially dedicated to HIV patients later expanded to a broad primary care program for those with multiple serious chronic illnesses — just those who are among the 5% of individuals for whom 40% to almost 50% of all medical dollars are expended. The company, AbsoluteCare, opened a second program in Baltimore — a 17,000-square-foot primary care office in a new building to manage the care of “the sickest of the sick,” whose average annual claims approach $40,000 per year.

Their model has one PCP or NP per only 300 patients working with a team of case manager, medical assistant, and nurse. Other on-site professionals include a mental health therapist, psychiatrist, and social interventions. They also deploy a community-based team that cares for patients in their neighborhoods and homes. In addition to medical care, they address social issues that may impact health status, such as food, clothing, housing, and transportation. For example, they will pick up the patient, bring them to the office, and return afterward.

In essence, the center staff is providing dramatically enhanced primary care at a substantial additional cost over typical primary care but with the aim to improve health and thus lower total costs. Most of the initial patients were on Medicaid or in a Medicare Advantage plan and lived in economically stressed areas. AbsoluteCare now also has contracts with both local and national health plans and has operations in 6 cities, and continues to grow.

It is important to be repetitive here. This type of primary care costs much more than traditional primary care but the result, besides for much-improved patient health and wellness, is a major reduction in total health care costs. That’s why health plans representing Medicare and Medicaid are willing to be supportive. Good for them to have opted to give it a try, and it is working in multiple cities.

The Baltimore office, which I have visited twice, is notable for its ambiance, cleanliness, exceptionally courteous staff, the sense of fun yet seriousness, and the clear message that everyone really cares about the patients and is determined to develop a trusting healing relationship with each. Not exactly what one might expect in an inner city medical office that caters to the socially-economically disadvantaged.

A major focus is on the family and social situation — are they living alone, having transportation, or are they having difficulties with rent, phone, and heating bills?

Same-day visits are the norm; basic blood tests are done on-site, and IV therapies are available, as is an in-house pharmacy. General radiology is transmitted to a nearby tele-radiologist. In addition, the center has a cadre of specialists they tend to call upon for referrals — chosen not only for their expertise but also for their willingness to work in close coordination with the care team.

As Chief Medical Officer Dr. Greg Foti told me: “It is all about vigilance and caring. We must call the hospitalist if the patient is admitted. We must follow up with skilled nursing if needed. We must transport them here to ensure they get the care they need. We want to fully wrap our arms around all the factors that affect their health. We don’t have any magic bullets, but we can give true love and care to our ‘members.’ That will make the difference in both quality and costs.”

The Baltimore office is focused on ensuring that they provide quality care as measured by some standard parameters. “Before AbsoluteCare intervention, our traditional member population scores in the lower 30th percentile with most quality- and value-based purchasing outcomes. After Absolute Care intervention, our members have increased their quality- and value-based purchasing outcomes [such as blood pressure control, HbA1c control, etc.] into the 75thth-95th percentile. Our culture demands that success be tied to quality- and value-based purchasing performance.”

For the payor, these numbers are impressive: a sharp reduction in hospitalizations (down 50%), ER visits (down 34%), reduction in specialists visits (24%), and total costs of care by perhaps a third, a remarkable decrease for these very challenging patients.

But most important, patients have, probably for the first time, found compassionate, thorough, comprehensive, meaningful care that has had a positive impact on their health and their lives.

Many pressures are driving the need for alternative approaches to providing primary care. Enterprising physician entrepreneurs are often the drivers of paradigm change. The fundamental concept of this center and others like it is to offer expanded primary care with heavy use of resources to improve health and lower total costs. As Dr. Foti noted, “We cannot always cure these individuals of their chronic diseases, but we can make a big difference in each person’s health, in their ability to enjoy life and be productive.”

The patient gets extensive primary care not just with a doctor or nurse practitioner but also with a team including attention to social needs as well as medical and mental health requirements. The result is that the patient becomes much healthier and will be using fewer medical system resources, especially those that are exceptionally expensive, like ER visits, procedures, imaging, specialist visits, and hospitalizations.

It is time for insurers to recognize and support this type of care. It changes the payment model but will lower their total care costs.

The post Primary Care for the Sickest of the Sick appeared first on Medika Life.

Instead, as we rapidly approach the three year mark of the Covid pandemic, healthcare finds itself in many ways, far the worse for wear, not having benefited financially in any way from the pandemic. Staffing issues persist, doctors, nurses and healthcare professionals having abandoned their posts for greener and, let’s be honest, safer, working environments.

Nothing kills job satisfaction faster than the continued thought of catching a potentially fatal disease each time you go to work. Add to that, frustrated, aggressive and often abusive patients and you can see why many professionals opted for a career change.

Do We Now Face the Pandemic of Poverty?

For all the good our lockdowns did, and although debate still rages, it is safe to assume that the general consensus now is that they were a terrible, costly mistake, a collective lapse in judgement that the global economy is still staggering to recover from and never may. In lieu of pumping the American stimulus package into the expansion and development of healthcare for the afflicted, the U.S. opted to shut down its economy and pay the public trillions through its now infamous “stimulus” packages.

America was not alone and countries across the globe followed suit. Healthcare, our primary prerogative in times of pandemic, stood by and watched helplessly as trillions upon trillions of dollars flowed, not to healthcare, but into the hands of an imprisoned public.

The Pandemic Has Come, But the Ripple Effect of “Long-Covid” Remains

The pandemic has come, left its mark and although its impact is still felt as new variants sweep through populations, our fear has passed. We now view the disease as would influenza. It evokes a similar nonchalant response in the public, one of “just another disease we have to cope with” and life moves on. We have moved on. Healthcare hasn’t. Many areas are still beset by Covid outbreaks and now a gloomy shadow of another kind looms on the horizon. The long term impacts of Covid, so called “long Covid”, affecting millions and placing further burden on an already creaking healthcare infrastructure.

The Real Legacy of Covid

Perhaps the real legacy of Covid will not be that of the first truly global pandemic in living memory. Perhaps its true place in history will be as the trumpet call that heralded the beginning of the end of healthcare in modern American society. An opportunity missed to reinvigorate an industry with chronic shortcomings, to prepare it to meet the challenges of a new century. An industry desperately starved of investment and facing massive challenges in delivering care to those most in need.

Now, as the WHO braces itself for a possible new global threat from the Monkeypox virus, cases having doubled in the last two weeks, American healthcare finds itself poorly placed to respond. They are still struggling to come to terms with the aftermath of dealing with Covid, their resources, both human and mechanical, drained and supply chain issues still prevail.

In short, a perfect storm awaits. One we have engineered and enabled with poor choices and little foresight. Mark my words, should we be headed for another pandemic on the back of Covid, few will pay heed to the plight of their one true ally. Healthcare.

The post Did Healthcare Just Miss its Bus? appeared first on Medika Life.

My friend Susan in the first article of this series was a good example. Presenting to her PCP with a somewhat unusual symptom, she was sent from specialist to specialist without ever learning what was causing her symptom, much less resolve it. It was a true waist of time, money and her emotions when the answer was there if only a doctor spent some time to listen to her.

To further exacerbate the problem, the doctor and patient no longer have a “contract;”. The patient and doctor are bystanders to the decision-makers. Frustration by doctors and patients is high, and physician burnout has become rampant.

 Add to this is a significant change in the common serious diseases – complex, chronic illnesses, mostly preventable, for which American medical care has not established suitable methods of prevention or adequate methods of care. In addition, what should be the role of the primary care physician has been compromised by the insurance industry (both commercial and government-sponsored) that puts the incentives in the wrong places. The result is a sicker population, episodic care, and expenses that are far greater than necessary.

Our current delivery system was designed early in the past century with the expectation that the patient would pay the doctor a reasonable fee for the effort, skill, and time involved.

Insurance developed during the past 70 years initially to pay for unexpected, highly expensive care, such as surgery or hospitalization. But over time, insurance transitioned into what is essentially prepaid medical care and along the way eliminated the financial “contract” between you and your primary care physician (PCP or Nurse Practitioner.) The contract today for both you  and the doctor is with the insurer The patient and doctor are bystanders to the decision-makers. Frustration by doctors and patients is high, and physician burnout has become rampant.

Worse yet, insurance pays primary care providers a pittance, driving them to “make it up in volume” by seeing too many patients per day, often 24 or more. Of course, this means short visits, perhaps three per hour, which translates into about 10-12 minutes of actual face time with you.

The delivery system was developed to deal with acute medical problems, where it is reasonably effective. For example, consider the pneumonia that a single internist can treat with antibiotics, an appendicitis that can be cured by the surgeon, or the fractured arm that the orthopedist can cast. But our medical care system works poorly for most chronic medical illnesses and costs far too much. Chronic illnesses include diseases like diabetes with complications, cancer, heart failure, chronic lung and kidney disease, and Alzheimer’s.

These chronic illnesses are increasing in frequency at a rapid rate and consume the bulk of health care expenditures. They are largely (although not entirely) preventable.

A century ago, the most common causes of adult death were infections – pneumonia, typhoid, and tuberculosis. Today these are uncommon and treatable. Now the most frequent causes of death are chronic illnesses – heart, cancer, and stroke, with Alzheimer’s and diabetes just behind. Other than some cancer, most others are not curable.

Most chronic diseases are related to lifestyles and are preventable. A myriad of social, environmental, financial, and personal reasons has led to non-nutritious diets, lack of exercise, chronic stress, inadequate sleep, smoking, and excess alcohol. Obesity is now a true epidemic, with one-third of Americans overweight and one-third obese. The combined result is high blood pressure, high cholesterol, and elevated blood glucose, which, combined with the long-term effects of the above behaviors, leads to diabetes, heart disease, stroke, chronic lung problems, kidney disease, and cancer.

No one pays for prevention, for maintaining health and wellness. Insurance is for disease care. Government does little (except with tobacco) to assist. As a result, as a country, we do not attend to actual healthcare and maintaining wellness, which in turn means greater pressure on the medical care delivery system. We don’t have a health care system, it is a medical care system that focuses on disease, its diagnosis, and treatment. Wellness and prevention are largely ignored. That is unfortunate because most of today’s chronic diseases could be prevented. Attention to prevention is the logical method to maintain and improve health and is much less expensive than treating a disease once it occurs.

When any of these chronic diseases develop, except for some cancers, it usually persists for life. These are complex diseases to manage and are often very expensive to treat – an expense that continues for the rest of the person’s life. Preventing them is equally complex but a lot less expensive.

Although not adequately appreciated, primary care physicians can handle most of today’s chronic illness care. They have the knowledge, experience, and skill level to do so. But this does not happen with short visits. All too frequently, the patient is referred to one or multiple  specialists when the PCP could have dealt with the problem had they had enough time. That extra time would not have cost much, but the referral, of course, means an increase in the costs of care, often substantial.

Some patients with chronic illnesses will need a team of caregivers, but the various specialists and the PCP are not a true team working in a unified manner. For example, consider a patient with lung cancer who may need a surgeon, radiation oncologist, medical oncologist, pulmonologist, pain specialist, palliative care team, nurse practitioner, and many others. Primary care physicians generally do not have the time needed to coordinate the care by the specialists. This is very unfortunate because coordination is absolutely essential to ensure good quality at a reasonable cost. You might think that one of the specialists might take on that role but that rarely occurs. More often the patient starts with a surgeon who refers him on to a radiation oncologist who then refers to a medical oncologist who then may or may not call-in others as needed. 

Any team needs a quarterback, and in general, that person is or should be the primary care physician. The PCP needs to be the orchestrator of the various specialists when needed in these complex patients. This need for a team and a team quarterback for the patient with a chronic illness is much different than the needs of the patient with an acute disease in which one physician can usually suffice. A team quarterback dramatically reduces the total costs of care if only because it means continuity and organization of care, keeping the patient’s welfare upper most in mind.

This shift to a population that has an increasing frequency of chronic illnesses mandates a shift in how medical care is delivered. Unfortunately, our delivery system has not kept up with the need. This is no way to run a railroad.

Join me with the following articles as I address more of the Whys and Hows and What to Do.

The post Complex, Chronic Diseases Are Rampant Today appeared first on Medika Life.

On the one hand, we have incredible science, technologies, drugs, devices and providers. On the other hand, we have a truly dysfunctional healthcare delivery system.

America has exceptionally well-educated and well-trained providers committed to your care.

America is the envy of the world for its biomedical research prowess uncovering the basic science of human biology, funded largely by the government via the National Institutes of Health and conducted across the county in universities and medical schools.

The pharmaceutical and biotechnology industries continuously bring forth lifesaving and disease-altering medications.

The medical device industry is incredibly innovative and entrepreneurial. The makers of diagnostic equipment such as CT scans and handheld ultrasounds are equally productive. 

Consider these examples: The science of genomics is revolutionizing medical care in profound ways, such as producing targeted cancer drugs, predicting later onset of cardiac disease, offering prognostic data to guide cancer treatment, rapidly identifying bacteria and its antibiotic susceptibility, indicating whether a drug will work in a specific person and determining if a drug will cause a side effect in that person. 

The pharmaceutical industry has brought us statins to reduce cholesterol, drugs to prevent blood clotting and effective means to control high blood pressure. The rapid development of multiple vaccines and treatments against Covid-19 has been an incredible tour de force.

The device industry has created a potpourri of new approaches that have transformed, for example, cardiac care, including angioplasty, stents, pacemakers and intra-cardiac defibrillators. We even have the ability to replace the aortic valve without major heart surgery. 

Organs can be imaged noninvasively in incredible anatomic detail while also showing their inner cellular workings. The operating room is equipped with devices that make surgery less invasive, more effective and much safer.

Simulation technology has completely changed how trainees learn the basics of procedures from the simple, such as drawing blood, to the complex, such as laparoscopic surgery and cardiac catheterization. Robots are assisting surgeons in open heart and prostate surgery and are integral to today’s large hospital pharmacies and central sterile supply systems.

We may be on the verge of using genetically modified animal organs transplanted to humans for heart, lungs and kidneys.

The electronic medical record allows rapid access to information at any time and place, helps the physician to select the correct medication and dose and speeds up prescription transfer to the patient’s local pharmacy.

Radiology and pathology images can be sent via the Internet to a distant site for interpretation by a specific expert. A video of an ongoing surgical procedure can be evaluated by a distant authority in real time to give advice to the operating surgeon, such as in a battlefield situation far from home. And some surgery can even be done distantly via robotic controls.

We can be appropriately awed, proud and pleased about what is available for our care but to a large degree, we don’t fully benefit because —

We have a very dysfunctional health care delivery system. It is highly flawed and just does not work well.

Image from Peterson KFF Health System Tracker

America spends nearly 20 percent of its Gross Domestic Product on medical care, which is double that of the average of 9.9% for the other 34 economically-developed countries (such as Canada, Britain, France, Germany and Japan) in the Organization for Economic Cooperation and Development. On a per capita basis, America spent ~$12,000 on health as of 2020, which is more than twice the average of the other countries and well above Switzerland, the second highest country in expenditures, at ~$7000.

Despite these expenditures, our lifespans are somewhat shorter with Japan and Hong Kong at the top of the charts averaging 85 years and the United States ranked at number 46 with an average of 79 years and falling somewhat in the past few years. This decline is not for lack of medical advances but is rooted in the social determinants of despair and disease and the linked epidemics of obesity and type 2 diabetes.

There are thousands of preventable hospital deaths each year, and there are ~100,000 deaths due to hospital-acquired infections.

On a direct personal basis, you experience the dysfunction personally in many venues. You pay a high price for your health insurance yet you get only 15 minutes with the doctor. You are frustrated, perhaps angry and the doctor is equally frustrated and increasingly burned out. Tests and procedures are way overutilized. Trips to the ER and admissions to the hospital are much greater than necessary. Plus, these incredible technologies and lifesaving drugs are often used in ways or settings in which the marginal benefit barely, if at all, exceeds the marginal cost.

This is not an enviable record.

A report from the National Research Council and Institute of Medicine, summarized in the Journal of the American Medical Association, found “the health outcomes [of the United States] are generally worse than those of other wealthy nations. People in the United States experience higher rates of disease and injury and die earlier than people in other countries. Although this health disadvantage has been increasing for decades, its scale is only now becoming more apparent.”

Although there is better control of high blood pressure and cholesterol and there are lower cancer and stroke mortality rates, U.S. citizens have a lower life expectancy, higher infant mortality, higher rates of premature birth and thus lower birth weights, a higher incidence of HIV-AIDS, the highest prevalence of obesity and diabetes and the second highest rate of death from coronary artery disease, among other ills. To repeat, this is not an enviable record, especially given the level of expenditures. 

In sum, the paradox is that America has the providers, the science, the drugs, the diagnostics and the devices needed for outstanding patient care. But the delivery of care is dysfunctional at best and far too expensive. You are not getting the full potential of care that could and should be available and you are paying too much for what you do get.

In the articles to follow, I will delve into the what’s and why’s of this predicament along with practical approaches to improvement. Please join me.

The post The Paradox of America’s Healthcare System appeared first on Medika Life.