Healthcare Crisis: A Broken System in Need of True Reform
Today’s healthcare industry is in crisis. Access to quality healthcare is diminishing, billions of dollars are being wasted, and millions of people are going without care. These problems are being complicated by the majority of medical students choosing to specialize rather than go into primary care. Healthcare reform legislation is taking steps to address some of these problems, but significant progress remains nonexistent.
What is the cause? Health insurance - a product originally created to cover unplanned serious illnesses and crises – has grown to manage our routine, everyday health needs.
Insurance remains a critical element in the healthcare of Americans - for expensive, unusual, unpredictable events. When health insurance is used as a payment system for everyday healthcare, significant problems arise. When insurance infrastructure is used to administrate the high utilization and low cost of primary care, it actually makes primary care more expensive and less effective.
Americans are paying more, but getting less for health insurance:
· The costs of employer-based health insurance premiums have risen 114% since 2000.1
· Americans are paying higher deductibles. The average family deductible increased from $1,034 in 2006 to $1,518 in 2010.1
· American families aren't only paying higher deductibles, but higher copayments as well. In 2004, only one in five people with health insurance through an employer had a copayment of more than $25. In 2008, that number was one in three. In 2009, it was nearly one in two.2
· A middle-income family with individual coverage spends an average 22% of household income on health care while a similar middle-income family with employer based coverage spends about 8% of their income on health care costs.3
Millions of Americans are going uninsured or underinsured because of escalating health care costs, decreased access to health care and gaps in quality of care.
· 86.7 million Americans were uninsured at some point during 2007 and 2008.4
· Working families make up 80% of the uninsured.5
· Insured Americans are going without needed medical care due to expensive copayments and deductibles.6
Primary Care Defined
According to the American Academy of Primary Care, primary care is defined as:
“Care provided by physicians specifically trained for and skilled in comprehensive first contact and continuing care for persons with any undiagnosed sign, symptom, or health concern not limited by problem origin (biological, behavioral, or social), organ system, or diagnosis. Primary care includes health promotion, disease prevention, health maintenance, counseling, patient education, diagnosis and treatment of acute and chronic illnesses in a variety of healthcare settings. Primary care provides patient advocacy in the healthcare system to accomplish cost-effective care by coordination of healthcare services. Primary care promotes effective communication with patients and encourages the role of the patient as a partner in healthcare.”
Take a moment and examine the primary care services you receive. Does the above definition describe what your primary care looks like?
1. Diagnosis and treatment of acute and chronic illness? Check. We all currently get this through our healthcare providers.
2. Health promotion? Does your doctor promote good health to you?
3. Disease prevention? Does your doctor discuss with you and implement methods to prevent disease?
4. Health maintenance? Does your doctor work with you to maintain good health?
5. Counseling? Do you receive counseling from your doctor?
6. Patient Education? Do you receive education during your visit about your body chemistry, physiology, health status, medications, testing, results, or treatment plans?
Do you have the “how” and “why” questions answered, or does the nurse simply pat you on the shoulder and tell you your tests were normal?
Do you believe your healthcare is cost-effective?
· The average person visits their primary care provider 3 times per year, and consumes no other healthcare services.7
· The average primary care visit lasts 15.7 minutes.7
· The average annual insurance premium is $6,797 per person.7
When calculating the average premium cost in proportion to the average consumption, the ratio is:
$2,265.67 per 15.7 minute visit…or $8,658.62 per hour.
Is your healthcare a partnership?
Are you knowledgeable enough to engage as a partner in your healthcare, or do you simply trust whatever your doctor says? Most people blindly trust their doctor. Do you take this approach with your finances, your business, or any other area of your life?
What role does your insurance play in your relationship with your physician? Insurance companies dictate the delivery of care, as well as payment for services rendered.
According to a study by Health Services Research8:
· Median visit length = 15.7 minutes
· Median of six topics
· About 5 minutes spent on the longest topic.
· Remaining topics each received 1.1 minutes.
The study conclusion:
Many topics compete for visit time, resulting in small amounts of time being spent on each topic. A highly regimented schedule might interfere with having sufficient time for patients with complex or multiple problems. Efforts to improve the quality of care need to recognize the time pressure on, patients and physicians, the effects of financial incentives, and the time costs of improving patient–physician interactions.8
A typical primary care visit:
1. Patient presents with a Chief Complaint
2. Testing may or may not be performed
3. Diagnosis is made
4. Symptoms are treated.
5. Visit ends.
Does your physician perform everything referenced above, or does your physician simply manage and control your symptoms? If you are obese and have high blood pressure, does your physician work with you in a way to resolve your condition, or does your physician simply prescribe medication to control your blood pressure…until it becomes uncontrolled and your physician decides to increase your dosage?
This is a very REACTIVE approach to medicine…and it is failing.
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Originally Posted by RhythmDawg
