The United States is failing one of its most important obligations, namely the health and well-being of its citizens. In doing so, it cannot describe itself as a successful nation.
This is a recent cruel conclusion Mirror, Mirror 2024: A Portrait of a Failed US Health Care System Commonwealth Fund report on health care in rich countries. According to the report, the United States is the lowest ranked system as a whole, despite the fact that it spends by far the most money on health care.
In four out of five categories, the United States ranks either lowest or second lowest in the study, which compared the health care systems of ten wealthy countries. These four categories are access to care, administrative efficiency, equity, and health outcomes.
“Most of the countries we compared offer this protection, although each can learn a lot from the others,” the report states. “A United States that fails this ultimate test of a successful nation will fall by the wayside.”
Where is the incentive?
Misaligned incentives play a role in this dismal outcome, said Lucienne Ide, MD, Ph.D. and CEO at Rimidi, a patient monitoring company.
The U.S. health care system leaves 26 million people uninsured and even more underinsured, preventing people from getting care until the last, expensive moment, he said. In addition, the lack of effective primary care infrastructure significantly contributes to the lack of preventive screening and better quality disease management.
“One of the great paradoxes of the American health care system is that if you’re seriously ill, there’s nowhere else you’d rather be,” he said. “However, if you want accessible, affordable preventive care, the United States is the last place you want to be.”
Alexandra Tien, MD, a family physician at Medical Associates of Rhode Island, agreed that the health care industry is talking about the importance of primary care.
“Primary care doctors are the lowest paid doctors, and until that changes, medical school graduates with hundreds of thousands of dollars in debt (because we don’t subsidize medical education in this country) will surely flee primary care just as quickly. as they can,” he said. “As a country, we talk about the importance of primary care without paying primary care doctors accordingly.”
Current health care incentives aren’t actually about providing the best possible care to patients, but rather are driven by revenue opportunities, said Warris Bokhari, MD, founder and CEO of Claimable, an AI-powered health insurance company. He said insurance companies and health systems benefit from such incentives, not patients.
“Our system encourages short-term gains over long-term health outcomes, making business performance the primary measure of success,” he said. “Ultimately, the two industries — medicine and insurance — are tied in name only, leaving patients in a system that treats care as a line item, not a commitment.”
In addition, increasingly larger health systems are buying more and more formerly independent practices, further increasing costs for patients, Bokhari added.
Not just hospitals
The dysfunction extends to the entire health ecosystem. Pharmacists and dentists experience similar complications, and they should also be considered when discussing the issues plaguing the entire US health care system.
For example, the combination of pharmacy benefits management and digital health facilities highlights high costs, administrative inefficiencies and deficiencies in primary care, says Lindsay Dymowski, CEO of Philadelphia-based Centennial Pharmacy Services.
Also in dentistry, better integration of oral health into the ecosystem would help to build a bridge between it and general health.
“The shift to value-based care, where providers are rewarded for quality care and health outcomes rather than the quantity of care provided, encourages prevention and individualization of care,” said Melissa Burroughs, director of policy at the Boston-based CareQuest Institute. For Oral Health.
The individual patient-physician relationship has been largely forgotten as health systems and insurance companies focus on business concepts like “productivity” and “consumer-driven needs,” and nowhere is this more evident than in the failures of primary care. argued Dr. Drew Remignanti, MD, a retired emergency physician and author The Healing Connection: a partnership for your health.
“Only through a trusting and mutually respectful patient-physician relationship can we safely navigate the real issues of modern health care,” he said. “That’s why we need to encourage primary care for both patients and doctors.”
Social factors do indeed determine
Health disparities are prevalent in such a dysfunctional system, where about 80% of health outcomes are influenced by the social determinants of health, while actual clinical care contributes to 20%, said Didier Choukroun, CEO of SPHERE Investments, a Miami-based real. a real estate company focused on improving healthcare environments.
Investments must be aimed at improving socio-economic factors, the physical environment and health behavior in order to promote health equality. This kind of focus can also be helped by a greater focus on value-based care, Choukroun said.
The reality is that without the necessary measures to ensure adequate primary care for all from an early age, many people enter the Medicare years due to chronic conditions and low health literacy, increasing costs and reducing the effectiveness of value-based care initiatives. says Jenn Kerfoot, Strategy and Growth Director of DUOS. A digital health innovator whose goal is to help older adults live more independently.
“By ensuring that every American has access to a foundation of health information and preventive care, we can reduce costs, reduce the burden of chronic disease and ultimately allow Medicare to better fulfill its mission for generations to come,” he said.
According to sources, treatment must be easier and more affordable for patients, while being more profitable and sustainable for providers. Emphasizing the health of individuals in a country where life expectancy is four years below the average for other countries must be prioritized above the lowest health.
“The bottom line is that the cost of health care in the United States is the highest in the world, and we have little to show for it,” Tien said. “The main reason for this is our dependence on the middleman and the proliferation of bureaucrats, all designed to make our ‘system’ unnecessarily complex and tangled in a dysfunctional mess.”
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In addition to the United States, the countries surveyed for the report were: Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland and the United Kingdom. Australia was the best overall system and one of the countries that spend the least on healthcare.
“Reversing the dark history of the U.S. health care system would require multiple, demanding actions by government at all levels and the private sector,” the report states.
Nick Thomas is a writer living in Denver.
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