The link below is to a brilliant clip from the HBO series Newsroom. If you haven’t seen it, watch it. If you have seen it, watch it again:
The United States of America is often referred to as the greatest country in the world. And while this may hold true in some facets of our society, there is overwhelming evidence to suggest that healthcare isn’t one of them. We’re ranked #34 in the world for life expectancy, #40 in the world for infant mortality, and our #1 cause of bankruptcy is medical expenses. While those statistics aren’t quite as bad as those quoted by Jeff Daniels in his Newsroom rant above, they’re not the vital signs of a healthy medical system: they’re the dashboard of a system in crisis. But, the patient isn’t dead yet, and there is still hope to revive the system that millions of Americans rely on everyday. Here are our top 5 ways we can fix healthcare in America:
- Re-engage the patient as the owner of their care. People who are treated like children can be expected to act like children, and this is particularly true of the way in which patients are managed in US hospitals. Guided from one department to the next with little information on their condition and minimal access to their records, patients are forced to place all responsibility for their care in the hands of doctors. Open access to information, namely their patient health record, combined with new healthcare technologies such as wearable devices, can put this responsibility back on the patient and make them an owner of their healthcare team. With the support of their coaches (also known as their primary care provider, nutritionists, doctors, nurses and specialists) and team mates (such as friends, family members and work colleagues) the goal of better health can be achieved.
- Have the difficult conversation around end of life healthcare. As our population grows older we face a moral dilemma – how long should we prolong life for the sake of living? Beside the cost to insurers such as Medicare (which can be as high as $50 billion per year) there is also the question about how we want to spend our final days – will it be in ICU with beeping machines and tubes, or in relative comfort at home surrounded by loved ones. Fact: 30% of all Medicare expenditures are attributed to the 5% of beneficiaries that die each year, with 1/3 of that cost occurring in the last month of life. How do we measure quality of life when the patient often can’t communicate? Sometimes the family’s desires differ from what the patient would have wanted for a broad variety of reasons. Advanced directives can certainly help, but more needs to be done. It’s time to have a conversation about when it’s o.k. to let nature take its course and allow death with dignity.
- Change patient behavior through economic incentives. There’s no question that drinking or smoking to excess has negative health impacts. The question now is how do we incentivize a change in behavior to reduce the burden of preventable conditions caused by these activities and their effect on our healthcare system? One method is to tie insurance premiums to these behaviors in the same way as a pre-existing condition would influence our payments. This is also a critical part of re-engaging people in their own care: creating a tangible link between lifestyle and health. Step away from the bad behaviors and stop treating health care like a endless buffet.
- Eliminate healthcare as the #1 cause of bankruptcy in America. A 2009 study found that medical debt was the leading cause of personal bankruptcy in the US. Of those filing for bankruptcy, approximately 60% held insurance but had incurred substantial costs due to gaps in coverage. People have lauded the ACA as being responsible for helping insure more people, but the fact is large portions of those who have signed up are now underinsured and are surprised by their high deductibles and what they still owe after a doctor’s office visit or a trip to the ER. Many potential patients go unseen by medical professionals as they avoid visiting hospitals in fear of accruing more debt. This is a phenomena unique amongst developed countries, where the majority of nations offer a universal public healthcare system that creates a safety net. It’s time to reexamine how insurers structure their policies and create an environment that encourages preventive healthcare and wellness to the benefit of both patients and providers.
- Increase transparency and reduce complexity in healthcare products and pricing. A lack of transparent pricing, meaningful education and the ever growing complexity of our health insurance products have conspired to make it impossible for the average American to be a good consumer of healthcare. How much should an MRI cost? What is left on my deductible? Which doctor has the best track record on the procedure I need? What the heck is a DofR (Division of Financial Responsibility)? All good questions with no easy answers in today’s environment. For patients to be able to take control, they will need simple, easy to understand tools, reports and mechanisms to make informed decisions about their care, where it is given and the quality performance of who is giving it.
Those are our top 5 ways to fix healthcare in America. By no means an exhaustive list, but a good start in our eyes. Help us keep the dialogue going. Share your thoughts in the comments or join the conversation by using the hashtag #HumanizeHealthcare on Twitter.