Here’s a question that’s been on my mind and perhaps yours: Is the US healthcare system expensive, complicated, dysfunctional, or broken? The simple answer is yes to all.
Below are 10 of the most convincing arguments I’ve heard that our system needs a major overhaul. And that’s just the tip of the iceberg. Remember, an entire industry has evolved in the US just to help people navigate the maddeningly complex task of choosing a health insurance plan.
Financial burden. High costs combined with high numbers of underinsured or uninsured means many people risk bankruptcy if they develop a serious illness. Prices vary widely, and it’s nearly impossible to compare the quality or cost of your healthcare options — or even to know how big a bill to expect. And even when you ask lots of questions ahead of time and stick with recommended doctors in your health insurance network, you may still wind up getting a surprise bill. My neighbor did after knee surgery: even though the hospital and his surgeon were in his insurance network, the anesthesiologist was not.
Healthcare disparities. The current US healthcare system has a cruel tendency to delay or deny high-quality care to those who are most in need of it but can least afford its high cost. This contributes to avoidable healthcare disparities for people of color and other disadvantaged groups.
Health insurers may discourage care to hold down costs. Many health insurance companies restrict expensive medications, tests, and other services by declining coverage until forms are filled out to justify the service to the insurer. True, this can prevent unnecessary expense to the healthcare system — and to the insurance company. Yet it also discourages care deemed appropriate by your physician.
A new study by a team from the University of Michigan Institute for Healthcare Policy and Innovation shows that adults over age 50 place more importance on convenience-related factors, rather than reputation, when choosing a doctor.
The study, based on data from IHPI’s National Poll on Healthy Aging supported by AARP and Michigan Medicine, still shows that online ratings and reviews of physicians play an important role, and should receive attention from providers and policymakers.
Dr. Jeffrey Kullgren, a U-M primary care physician and lead author of the study, describes the findings.
Cataract surgery is one of the safest and most effective types of surgery. In about 90 percent of cases, people who have cataract surgery have better vision afterward. Learn more about aging and your eyes at: https://www.nei.nih.gov/learn-about-e….
The Best Hospitals Honor Roll highlights 20 hospitals that excel across most or all types of care evaluated by U.S. News. Hospitals received points if they were nationally ranked in the 16 specialties – the more specialties and the higher their rank, the more points they got – and if they were rated high performing in any of the 10 procedures and conditions. The top point-scorers made the Honor Roll.
For the past 10 to 15 years, virtual health has been heralded as the next disrupter in the delivery of care, but there has been minimal uptick in adoption. The COVID-19 pandemic is pushing against structural barriers that had previously slowed health system investment in integrated virtual health applications.
“As this epidemic makes clear, at any moment, any of us could become sick, could become hospitalized, could be on a mechanical ventilator,” said Adam Gaffney, an ICU doctor in Boston. “And that, in the United States, could mean potentially ruinous healthcare costs.”
With over 21,000 people dead and more than a 547,000 infected with the coronavirus in the US the last question on a person’s mind should be how they will pay for life-saving treatment.
There were 27.9 million people without health insurance in 2018, and record-high unemployment will increase that figure by millions
But as the death toll mounted, a patient who was about to be put on a ventilator in one of New York City’s stretched to capacity intensive care units had a final question for his nurse: “Who’s going to pay for it?”
HCCI Releases 2018 Health Care Cost and Utilization Report
Per-Person Health Care Spending Grew 18% from 2014 to 2018, Driven Mostly by Prices
The report examines four groups of health care services and dozens of sub-categories. Of the four major categories, outpatient visits and procedures saw the highest 2018 spending increase (5.5%). Other notable trends include:
Per-person spending on inpatient admissions rose 11.4% between 2014 and 2018
Within each sub-category of inpatient admissions, average prices grew steadily between 2014 and 2018 while utilization trends varied. However, the 2.0% price increase in 2018 was lower than the near 4% annual increases from 2014 to 2017.
Increases in prices and use led to a 16% increase in spending from 2014 to 2018.
ver that period, ER visit spending increased 32% and spending on observation stays went up 29%.
Spending increased 16% and growth accelerated over the 5-year period, driven by office visits and administered drugs.
Psychiatry also saw strikingly high spending growth of 43% from 2014 to 2018, which was driven mostly by increased use.
Generic drugs accounted for 88% of all prescriptions. .
Out-of-pocket payments for prescriptions for generic drugs was less than one-fifth of out-of-pocket payments on brand drugs.
From a JAMA Network online study (February 11, 2020):
In this analysis of commercially insured patients who had undergone elective surgery with an in-network surgeon at an in-network facility, approximately 1 in 5 received an out-of-network bill, with a mean potential balance bill of $2011.
In this retrospective analysis of 347 356 surgical episodes among commercially insured patients who had undergone elective surgery with in-network primary surgeons and facilities, 20% of episodes involved out-of-network charges.
The patterns of out-of-network bills varied with the clinical scenario. Simpler ambulatory procedures that tend to involve 1 surgeon (arthroscopic meniscal repair, breast lumpectomy) had fewer out-of-network bills (13%-15% of cases), whereas inpatient procedures (hysterectomy, knee replacement, colectomy, CABG surgery) had more frequent out-of-network bills (24%-33% of cases). These more complex procedures were also associated with larger potential balance bills, in the range of $2000 to $4000.
From a The BMJ Views and Reviews article by David Oliver (February 5, 2020):
Last year the Lancet published a paper on the impact of wearing gowns, surveying 928 adult patients and carrying out structured interviews with 10 patients. Over half (58%) reported wearing the gown despite feeling uncertain that it was a medical necessity. Gown design was considered inadequate, with 61% reporting that they struggled to put it on or required assistance and 67% reporting that it didn’t fit. Most worryingly, 72% felt exposed, 60% felt self-conscious, and 57% felt uncomfortable wearing the gown.
I’ve often wondered why on earth we routinely put so many patients into hospital gowns within minutes of their arrival at hospital.
Sometimes referred to as “dignity gowns,” such dignity as they afford is only in comparison to being stark naked. They don’t come in a wide range of sizes or lengths, and they’re open along the back. You tend to get what you’re given and make do. The effect is to leave patients with lots of exposed flesh, with underwear or buttocks intermittently displayed and a feeling of extreme vulnerability, not to mention being cold if they have no other layers to wear.
In rural towns across the U.S. hospitals are in crisis. Since 2010, 121 rural hospitals have closed. And, the National Rural Health Association says more than one-third of all rural hospitals in the U.S. are at serious risk of shutting down.
But not all hospitals are losing money. A series of mergers and acquisitions that began in the 1990’s has created massive hospital groups. Many of these hospital consortiums are turning huge profits every year by offering high priced services to well insured patients.