Can US Healthcare be Affordable?

Abhinav Shashank
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The United States is one of the most developed countries in the world, but the complexity in healthcare keeps increasing, the costs keep increasing, and the results are hardly in line with the goals. When a country is spending over 17% of its multi-Trillion Dollar GDP on health, then one expects better outcomes and not the likes of what we are witnessing today.

Affordable Care Act (ACA) introduced in 2010 was surrounded by a lot of expectations and what it could achieve, has been short of those. The problem is not just that the costs are increasing, but the doctors are finding it hard to cope up with this ever-shifting paradigm.  US Healthcare industry’s present is in a worrisome situation, a blend of troubles encompassing various fields like cost, quality, technological advancements, etc.

 

Troublesome Aspects of US Healthcare

Payment and Costs

By nature, US Healthcare is a ‘multi-payer’ system, which brings up questions in a layman’s mind like, “Who will pay for me?” It is neither completely covered by the government nor by private entities. Unlike UK where government covers the people or Canada where the government provides basic health coverage to everyone, and additional coverage is available from private entities. This multi-tiered system of US today sees millions of citizens resorting to out-of-pocket payments. Americans who are not covered by Medicare and Medicaid and cannot afford to pay monthly premiums are forced to pay out-of-pocket.

Even when the government isn’t covering all the citizens and not all are insured, still the cost of care in the US is very high. This is an added pressure as the quality isn’t justifying the expenditure and other countries spend way less than the US and are doing better.

  • The average per person expenditure on health in the US is over $9000 which is approximately 30-40% higher than the second country in the list.
  • US Healthcare yearly spending is over $3 Trillion.
  • The share of economy spent on health care is 17.5%, which is expected to cross 20% within next ten years.
  • The retail prescription drug expenditure grew by 12.2% in 2014 as compared to 2.4% in 20113!
  • Expenditure on hospital care has increased by to $971.8 billion which is a 4.1% increment over the previous year.

Increasing Complexity

The complexities in US healthcare are many and spread across various fields. First the concept of “Primary Care Physician,” which increased the complexity of care theoretically. If a person sees a Primary Care physician, then he’ll see this doctor for regular checkups, and if he needs to see a specialist, then he’ll have to get a referral from the PCP for it.

The next and the biggest complexity is in the sharing of information. There are so many disparate sources of data that a physician can’t possibly get access to the relevant data about the patients’ history. If a PCP has a new patient, then he needs to know the past of that patient, but without efficient Health Information Exchange, it is just not possible. This is a direct result of lack of apt technology.

  • Every year US healthcare industry is losing $8.3 billion dollars due to inefficient healthcare technology.
  • 95% providers find it difficult to integrate data in EHR.
  • The US has the most number of preventable deaths
  • The life expectancy in the US is the lowest among the OECD nations.

Waiting Time

The amount of waiting time for a person to see a doctor has increased since Affordable Care Act where millions got access to health cover. People getting health cover is great, but the lesser number of practicing physicians is an area of concern. The waiting period to get an appointment for some non-pressing issues could be in weeks and in the case of specialists it could be in months.

  • The number of practicing physicians in the US per 1000 people is 2.6, which is lower than the OECD average of 3.2.
  • The number of hospitals beds in the US per 1000 people is 3.1 lower than the OECD average of 4.1.

 

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The Best Course of Action

For US Healthcare to improve the current standards, it is imperative that everyone understands what healthcare industry is going through and what healthcare community needs.

Ease of Care

Doctors should be able to treat their patients the way they had been doing. Today, they deal with complex EMRs and interact with data which isn’t easy to decipher even for an IT person! Doctors should be able to access the data just by “point-and-click,” and rest analytics on the population should be automated. It is already hard for them to cure patients that they can deal with the added tension of disparate data sources.

Differentiation between payments and incentives

Today, Healthcare industry is trying to transition to Value-based care model from fee-for-service model, which is why it is important that everyone gets the distinction between payments and incentives. Fee-for-service will not be out of the picture until and unless providers get incentivized for their efforts towards transitioning to value-based care model. A physician is more likely to spend on population health initiatives if he gets equally rewarded for it. Once fee-for-service is out of picture and value is the focus, efficiency in health care will increase to a huge extent.

 

Better Quality of care with Population Health Initiatives

The quality of care can be improved dramatically if patient-centric care is the primary objective through population health management.

Understanding Population health trend: After integration of data of millions of patients from disparate sources, a value-focused organization can learn about the population health trend like risks, widespread cures, cost, quality, etc.

Care Coordination: Keeping track of every patient so that every patient gets attention and has a care plan during the time of occurrence of an acute episode.

Patient Engagement: Advanced analytics can help in assigning risk scores to all patients, and this could assist in identifying at-risk patients and engaging with them to prevent an acute-episode.

 

The Road Ahead

Recently, there have been several reforms in the policies governing the U.S. Healthcare. No doubt, with the introduction of ACA, a huge difference has been made in care delivery and to some extent has proved resourceful in reducing the immense uninsured rate; and this might only be the tip of the iceberg as we find out in years to come.

When there are many problems, the indication is that there is an equal number of opportunities. US Healthcare might be costly, but the efforts are as always underway in making it better. The right direction and charged efforts can guide us to the end of the tunnel, where there are affordability and equitability in healthcare.

 

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