The United States spends the most money per person on healthcare, averaging 2-4 times what other industrialized countries pay. This might not be a problem if we received the best health outcomes as a result. Unfortunately, the opposite is true. The US has the poorest health outcomes in the industrialized world. The US ranks 33-36 in the world with results that are comparable to Cuba, Costa Rica and Chili regarding health outcome measures such as infant mortality rates, number of chronic diseases and life expectancy.
For decades, complaints have been leveled at various aspects of the US healthcare system that could improve outcomes, but little was changed. Eight years ago, after repeated reports pointed out that the US healthcare system was the most expensive, yet delivered poor quality outcomes, momentum built to finally succeed in achieving reform. What resulted however, was a change in how healthcare was paid for rather than modifying factors which delivered better health results. The healthcare reform that is so sorely needed in this country turned out to be little more than health insurance reform.
It is very important not to confuse these two. Many assume that if you increase the availability of healthcare services to people who cannot afford it because of limited or no insurance, their health will improve as well. The fallacy of this assumption has been demonstrated for decades with evidence measured by groups such as the World Health Organization, Organisation for Economic Co-operation and Development (OECD), and the Commonwealth Fund.
What is needed to improve the health of US citizens is not to increase access to the existing system that delivers poor results. Instead, we need to change factors that improve people’s health, such as who delivers what kinds of services.
The remainder of this article will briefly list some of the issues that impact the quality and types of care that can improve outcomes. With the 2016 presidential election results, it is anticipated that major change will be coming again to the US healthcare system. This time, let’s keep our eye on what really matters during these discussions (healthcare outcomes) so that we don’t get distracted again by things that turn out to have poor correlations with health (insurance systems).
Potential factors to reform that improve health outcomes include:
- Preventive services – address causes of diseases rather than waiting for diseases to emerge.
- Fragmentation of healthcare – establish a new profession supplying a better, holistic method of healthcare diagnosis & coordination of care. A Doctor of Interdisciplinary Diagnosis
- Objective vs. subjective diagnosis – Objective diagnostic tests measure signs that are visible to an independent observer or verifiable by equipment. A subjective diagnosis can only be confirmed by the patient and is relatively easy to consciously or unconsciously fake or distort. Objective testing is currently being severely underutilized for many conditions (i.e. learning, behaviour and emotional disorders).
- Symptomatic care vs. treating causes – cure problems, don’t just ‘control’ them. The state of understanding and research has progressed much faster than is put into common practice.
- Single vs. multiple mechanism approach – Many diseases have diverse factors that can contribute to causing it. It is important to identify a broad range of potential causal factors, test for which ones are involved and treat all the factors that research evidence points to as being capable of contributing to the condition.
- Conflicts of interest in healthcare delivery – Do you sell your jewelry to the appraiser or trust reviews written by the proprietors? Then why get treatment from the person who does the diagnosis? There is an inherent bias for the doctor to diagnose the condition from the perspective of the treatments they supply. Diagnosis supplied by physicians trained in a wide range of therapies needs to separated from the provider who supplies the treatment.
- Regulatory Reform – Government rules and laws are increasingly being written by special interest through revolving door relationships and legitimate or questionable funding mechanisms. Federal and state governments need to primarily represent the interests of the healthcare consumer.
- Direct to consumer marketing of prescription medications – The AMA and many other organizations have called for a halt to this practice. Drug marketing convinces patients to put pressure on their doctors to supply medications, even when the doctors feel it is inappropriate. This practice is only allowed in the US and New Zealand.
- Mandatory healthcare procedures – Any mandatory healthcare treatment which receives government enforcement measures, requires the highest levels of scientific, research, public and ethical support. Special interests must not be allowed to mold mandatory policy decisions in their favor through anything less (i.e. media control of public opinion or political influence). This is most critically important when the mandatory procedures carry with them morbidity and mortality complications.
- Personalized healthcare vs. protocols – Every person has different genes, chemistry, experiences, diets, lifestyles, etc. Evidence based treatment plans, insurance coverage and tort reform, needs to allow the flexibility to treat each person as an individual, not by a ‘one size fits all’ protocol book.
- Health literacy – Informed people make more preventive choices and have less hospital stays and fewer chronic conditions. Special interests have inappropriate levels of influence on all types of health literacy education from: physician education; medical research & journals on through to the mass media and public school education.
- ‘Mainframe’ vs. ‘mobile’ access – Technology has moved from large mainframe computers to mobile devices worn on wrists. Regulatory burdens have stifled development of the healthcare market from producing similar improvements in cost and availability. Sometimes these regulations are the result of a sincere desire to protect public health. Other times, it is the result of inappropriate special interest influence being wielded to protect market share.
Let’s create true healthcare reform in this country and deliver the results that are commensurate with the amount of money we are investing. I look forward to hearing your feedback.
Written by Dr. John M. Wallman, President – Diagnosis Foundation