The United States is failing in one of its primary obligations: the health and well-being of its people. By doing so, we cannot call ourselves a successful nation.
That's the grim conclusion of the Commonwealth Fund's recent “Mirror, Mirror 2024: Portrait of a Broken American Health System” report on health care across rich countries. The report says the United States ranks last in terms of the system as a whole, even though it spends by far the most on health care.
The study, which compared the health systems of 10 wealthy countries, ranked the United States last or second in four of the five categories. These four categories are access to care, administrative efficiency, equity, and health outcomes.
“Most of the countries compared offer this protection, even though each country can learn much from others,” the report concludes. “The United States remains an outlier in that it has failed this ultimate test of a successful nation.”
Where is the incentive?
Lucienne Ayde, MD, CEO of remote patient monitoring company Rimidi, said misaligned incentives are contributing to these dire outcomes.
The U.S. health care system leaves 26 million people uninsured and even underinsured, she said, discouraging people from accessing care until the last moment when it's costly. Moreover, the lack of effective primary care infrastructure plays a major role in further exacerbating the lack of preventive screening and better quality disease management.
“One of the great contradictions in the American health care system is that if you get seriously ill, there's nowhere else to turn,” she says. “But if you want accessible and affordable preventive care, the U.S. is the last place you want to go.”
Dr. Alexandra Tien, a family physician with Rhode Island Medical Associates, agreed that the medical industry pays lip service to the importance of primary care.
“Primary care physicians are the worst-paid physicians, and unless that changes, medical school graduates with hundreds of thousands of dollars in debt will no doubt continue to do so (because we don't subsidize medical education in this country). “I'll be running away from primary care as soon as I can,” she said. “As a country, we pay lip service to the importance of primary care, but we don't actually pay primary care physicians what they deserve.”
Wallis Bokhari, M.D., co-founder and CEO of Claimable, an AI-powered health insurance solicitation company, says that current incentives in the medical field don't actually provide the best possible benefits to patients. It said it is not aimed at providing care, but rather is driven by revenue opportunities. He said insurance companies and health systems, not patients, benefit from these incentives.
“Our system encourages short-term profits over long-term health outcomes and makes business performance the primary indicator of success,” he said. “At the end of the day, the two industries, health care and insurance, are tied together in name only, and patients are left in a system where they are treated as an item rather than a promise.”
Additionally, increasingly larger health systems are increasingly acquiring previously independent clinics, further increasing the burden on patients, Bokhari added.
Not just hospitals
This dysfunction is pervasive throughout the health ecosystem. Pharmacists and dentists experience similar complications, so this should also be taken into account when discussing issues plaguing the entire U.S. health care system.
Lindsey Dimowski, CEO of Philadelphia-based Centennial Pharmacy Services, said integrating pharmacy benefits management and digital health, for example, has led to high costs, administrative inefficiencies and It highlights issues such as lack of access to primary care.
In dentistry, we can build a bridge between oral health and systemic health by further integrating oral health into the ecosystem.
Melissa Burrows, director of public policy at the Boston-based CareQuest Institute, said, “The shift to value-based care is about providing quality care and health outcomes, not the quantity of care provided.'' “It will encourage prevention and individualization of care.” For oral health.
As health systems and insurance companies focus on business concepts such as “productivity” and “consumer-driven desires,” the one-on-one patient-physician relationship has been largely forgotten, leading to primary care failure. Nowhere is this more evident. Dr. Drew Remignanti, a former emergency medicine physician and author of The Healing Connection: A Partnership for Your Health, argues:
“It is only through a one-on-one patient-physician relationship of trust and mutual respect that we can safely navigate the vagaries of modern medicine,” he said. “Therefore, we need to encourage primary care for both patients and physicians.”
social determinants actually determine
Health disparities are rampant in these dysfunctional systems, with approximately 80% of health outcomes influenced by social determinants of health, compared to 20% influenced by actual clinical care. said Didier Chokroun, CEO of Miami-based real estate investment firm SPHERE Investments. A real estate company that focuses on improving the medical environment.
Investments must target strengthening socio-economic factors, the physical environment, and health behaviors to foster improved health equity. Such a focus will also be facilitated by a greater focus on value-based care, Chalkroan said.
The reality is that because everyone does not take the necessary steps to provide good primary care from an early age, many people enter the Medicare era with chronic conditions and low health literacy, resulting in increased costs. increasing numbers and decreasing the effectiveness of value-based care initiatives. “We're excited to partner with DUOS, a digital health innovator aimed at helping older adults live more independently,” said Jen Kerfoot, chief strategy and growth officer at DUOS.
“Ensuring that all Americans have access to the basics of health knowledge and preventive care will reduce future costs, reduce the burden of chronic disease, and ultimately make Medicare the future of health care.” It could enable us to better fulfill that mission for generations to come,” she said.
Stakeholders say healthcare must be more accessible and affordable for patients, while also being more profitable and sustainable for providers. In a country where life expectancy is four years lower than the average for other countries, focusing on individual health over bottom-line health must be a priority.
“The bottom line is that health care costs in the United States are among the highest in the world, and there is little to prove it,” Tien said. “The main reason for this is our reliance on intermediaries and the proliferation of bureaucracies, all designed to make our ‘system’ unnecessarily complex and dysfunctionally intertwined. .”
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In addition to the United States, the countries surveyed for this report included Australia, Canada, France, Germany, the Netherlands, New Zealand, Sweden, Switzerland, and the United Kingdom. Australia ranked highest across the system and was one of the countries spending the least on health care.
“Reversing the dismal performance of the U.S. health care system will require multiple rounds of rigorous intervention by all levels of government and the private sector,” the report concludes.
Nick Thomas is a writer based in Denver.
