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9 Big Challenges For The U.S. Healthcare System

Paras Shah, Paras Shah is an emerging physician and MedTech enthusiast. He has just completed his graduation in Medicine (MBBS) from GMERS Medical College, Vadodara, Gujarat and aspiring to specialisation. He has managed, led and hosted several events, seminars, conferences and workshops. He possesses various personal, interpersonal and business skills.

Patient’s expectations from healthcare service providers have changed a lot after the COVID-19 pandemic. One of the mightiest healthcare delivery systems in the world: The U.S. was brutally hit by COVID-19. It’s a time to analyse and eliminate the challenges which the U.S. is facing right now or will face in the near future. Patient experience, lack of workforce, expensive healthcare, cybersecurity and third party payment issues are some of the core issues in the U.S.

There is one question buzzing in everyone’s mind for a long time: How did the greatest healthcare system of the United States collapse during the COVID-19 pandemic? This tiny little virus has revealed the vulnerability of our healthcare industry. The U.S. has taken proper measures to enhance the consumer experience and healthcare delivery system. But a study[1] conducted by Public Agenda shows that only seven percent of Americans are satisfied with this present healthcare system. According to a Gallup Poll[2] which was carried out before COVID-19, seventy percent of Americans describe the current U.S. healthcare system as being "in a state of crisis" or having "major problems."

Rapidly changing government regulations, recovery from the pandemic, evolving MedTech, public perception and rising new opportunities have opened up a completely new level of service delivery for healthcare, but the path is full of challenges. So, let’s discuss some of the big challenges which are hindering the U.S. Healthcare System:
 
1. Shortage of Physicians and Nurses
According to a report published by AAMC[3], the United States could see an estimated shortage of between 54,100 and 139,000 physicians, including shortfalls in both primary and specialty care, by 2033. In coming years, the country will face a significant shortage of physicians due to this demand and supply issue. And the COVID-19 pandemic has made this problem prominent. The report also states that in the next 10 years more than two in five active physicians will reach retirement age and the rest of the physicians may retire early because of burnout.

Length and cost of training, limited residency spots, limitations on importing physicians and the aging population are some of the core factors responsible for so few doctors in the USA. However, this is not the only factor responsible for the consumer’s lack of access to primary healthcare.

2. Patient Experience
Earlier we talked about the poor public perception of the existing healthcare model. The medical insurance framework has gone through some significant changes over the past few years and many patients are paying a big chunk of money from their pocket despite having medical insurance.  Hence, naturally, consumers will demand better quality services from their providers.

Various healthcare service providers are competing with one another in order to retain and attract consumers. This leads to wasted time, money and efforts. Rather, these resources should be concentrated to develop a better service delivery model, to streamline healthcare and resolve the consumer’s queries and issues. The meaning of healthcare is not just limited to treating a patient, it’s a lot more than that. The patient-centric approach isthe only possible way to augment the patient’s experience. After all, the patient is at the centre of the entire healthcare delivery system.

3. Deteriorating Doctor-Patient Relationship
With each healthcare provider, the line of treatment may vary. Primary care physicians are usually the point of entry for most patients, but because of the fragmented healthcare system of the U.S., many consumers, as well as providers, find problems with care coordination. Over the past few years, the rates of amenable mortality across the country have also been poor. Amenable mortality measures premature deaths which could be prevented by timely intervention. According to an article published in BMJ[4], more than 250,000 deaths per year are result of medical errors and it is possibly the 3rd major cause of death in the U.S. Apart from that, there are long waiting periods to seek non-emergency medical consultations. There is also a big communication gap between doctors and patients. Although 89% of physicians accept to educate their patients about preventive measures, only 14% of patients remember about them. Compounding these issues and the current fee-for-service reimbursement system have downgraded the quality of the doctor-patient relationship.

4. Enormous Cost
According to U.S. Centres for Medicare & Medicaid Services (CMS)[5], in the year 2020, National Health Expenditure grew 9.7% to $4.1 trillion or $12,530 per person, which accounted for 19.7% of GDP. Even after spending a huge amount, the U.S. scores poorly on many key health measures than other high income nations. Many underinsured or uninsured people are always at risk of bankruptcy if they develop serious illness. Let’s compare some important procedures:

Cataract surgery in the U.S. may cost around $3,500 to $3,900 per eye; on the other hand, in the U.K. it costs around $2,400 to $3,000 and in a country like India, it ranges from $500 to $1800.

The C-section, without any complications might cost around $20,000 to $30,000 in the U.S., $8,000 to $15,000 in the U.K. and $1,000 to $3500 in India.

New technology, prescription drugs and diagnostic tests are some of the prime factors why the cost of U.S. healthcare is high. As the fear of being sued can prompt physicians to prescribe more diagnostic tests, which in turn increases the cost.

5. Lack of Transparency
Rival political parties possess different mindset on how the healthcare should run and each attempt to shape the system according to their ideologies. There is also a tug-of-war like condition between service providers and insurance companies and a consumer gets stuck in the middle. Healthcare providersupgrade the modality of treatment or medical procedure in order to get more money from insurance companies. Companies charge a high amount to employers and when it comes to paying off consumers, they get frugal and count pennies. This leads to so much dissatisfaction among consumers. This makes it difficult to establish long term solutions to the current problems of the healthcare system.

6. Uneven Access and Misdirected Distribution
Healthcare insurance is usually provided by the employer. A few people have private insurance also. But what if an employee loses a job? A layoff can put an individual in a condition where he can lose access to healthcare. There are so many disparities in healthcare service delivery. The large group which can’t afford some advanced care but needs it the most, doesn’t usually get it or get it lately. While the one who can afford the high cost gets access to care which he really doesn’t need. Sometimes, health insurers restrict expensive medications and various diagnostic tests by denying coverage and this discourages the quality of healthcare.

The distribution of efforts, resources and services seems to be misdirected. Insurance companies are ready to pay for the treatment modalities but they don’t bear the cost of preventive measures. Even the training protocol of physicians emphasises relatively less on preventive aspects. And due to malpractice lawsuits, physicians tend to remain defensive and that leads to overuse of resources. It also affects the quality of care.

7. Payment Processing Model
Healthcare providers’ revenue cycle usually struggles with the payment collection as the patients are liable to pay a large amount of money for their medical bills. And it is often challenging and efforts taking task to setup an in-house payment processing system. Providers are also supposed to follow all the guidelines as well as protect the patient’s information. Hence, the administrative cost keeps rising. It is very important for them to understand the whole ecosystem to reduce the cost and to stay profitable with improved patient outcomes.

8. Lack of Synchronisation
The U.S. healthcare system is quite fragmented. c. This leads to poor coordination of service delivery and repetition of blood tests or any imaging tests. Patients experience discomfort as they need to repeat the whole issue again before a new person. The lack of coordination and synchronisation wastes so much of time, money and effort. Due to rigid payment structures, home-based care for unable patients can’t be practiced. An inflexible healthcare framework doesn’t even allow physician assistants and nurses to provide basic primary care. Specialists have a lot more to deliver than primary care. Their skills, expertise, efforts, time, focus and attention should be directed towards resolving bigger challenges. Occupying specialists for unnecessary tasks is like using a sword for sewing.

9. Cybersecurity
A large amount of data is being generated every second in a scattered manner across the system. It’s very difficult to integrate that fragmented data and generate a precise insight. Data-driven decisions are the future of healthcare practices. But to generate, store and analyse the data coming from a variety of sources, there is no uniform setup available. Cybersecurity is also a matter of concern. Each year the U.S. experiences an increasing number of data breaches. Many providers don’t have HITRUST certification. It combines HIPAA, COBIT, HITECH, PCI and a few more safeguards. According to HIPAA Journal[6], from 2009 to 2021, 4419 healthcare data breaches of 500 or more records have been reported, which is a disclosure of almost 3.1 million healthcare records. With the growing MedTech partnership, it is important to protect patient’s information.

These are the various challenges waiting for U.S. healthcare to respond. The U.S. is a mini earth in itself as the majority of immigrants from various countries live there. Analytical mindset, skilful manpower, high level of commitment, dedicated attitude, logical intervention, outcome-oriented effort and progressive nature are some of the fundamental qualities which the United States holds. And everyone is sure that the authorities of the U.S. would definitely figure out these challenges!

Booster dose:
“It's more important to know what sort ofperson hasa disease than to know whatsort of disease a person has.”

-Hippocrates

References

1.    https://www.publicagenda.org/wp-content/uploads/2020/02/Taking-the-Pulse-Where-Americans-Agree-on-Improving-Health-Care_Final-2.pdf
2.    https://news.gallup.com/poll/245873/seven-maintain-negative-view-healthcare-system.aspx?utm_source=alert&utm_medium=email&utm_content=morelink&utm_campaign=syndication
3.    https://www.aamc.org/news-insights/press-releases/new-aamc-report-confirms-growing-physician-shortage
4.    https://www.bmj.com/content/353/bmj.i2139
5.    https://www.cms.gov/Research-Statistics-Data-and-Systems/Statistics-Trends-and-Reports/NationalHealthExpendData/NHE-Fact-Sheet
6.    https://www.hipaajournal.com/healthcare-data-breach-statistics/

Paras Shah

Intern Doctor, Department of Internal Medicine, GMERS General Hospital

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