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Why the American Health Care System Needs Reform

Understanding the Dysfunction of American Healthcare

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Updated October 16, 2008

It's difficult to find too many people in the United States who are satisfied with the healthcare system. Complaints run the gamut from the cost, to the abbreviated time spent with their doctors.

Even those who have good payment coverage, whether it's through an employer, or through a government program such as Medicare or Medicaid, recognize that they system has made it much more difficult to get the care they need at a price they can afford.

Here are some of the problems and frustrations that currently exist, that require some sort of adjustment to improve the system to make health care more affordable and accessible for all:

1. Quality of Care vs. Cost of Care

Most Americans would tell you that we have access to the best that medicine has to offer. And in the best-case scenario, that is true. Our doctors are among the finest in the world, the technology available is the latest and greatest, and the knowledge of diseases and possible treatments is excellent.

The problem is that the system has evolved to one where the balance between cost and access is at an all-time low. We hear that 47 million Americans have no health insurance or coverage. That means they can't access this excellence. We know that approximately 25 million are underinsured. In most cases, those people don't even realize what they cannot access because of cost.

According to the Commonwealth Fund, a private foundation that promotes better access, improved quality and greater efficiency in health care in America, the United States ranks 19th of 19 industrialized nations in quality of care. Further, the United States spends twice as much money per person as any of the others, and 101,000 Americans die each year just because they didn't have insurance.

2. Time vs. Quality of Care

You've heard the adage that time equals money. That's exactly how American healthcare providers must look at their own practices, if they want to stay in business.

Because the payment system is based on profitability or saving expense, doctors and other providers are forced to perform their duties in less time, see more patients in any given day, and look for other ways to save time so they can bill for more people and procedures in order to make the money they want or need to make.

The 20-minute appointment of yesterday, when you had time to explain your systems, then listen as your doctor explained your diagnosis or recommended treatment, has been replaced by a 10-minute appointment, mostly handled by a nurse or other assistant. Patients often complain that their doctors don't listen to them because they are in too much of a hurry.

The results are more mistakes, more misdiagnoses or missed diagnoses, even prescription errors. Further, we never get to know our doctors and the doctor never gets to know us, which is important as we age and need care that coordinates with our other medical problems.

3. Patient Safety

The time constraints lead to further safety questions. Safety problems account for 98,000 or more American deaths each year.

Surgeons in a hurry don't follow guidelines for "time outs" that assure everyone that they are operating on the right patient, the right body part, or even remembering to pull all the instruments and objects out of a patient when they are finished.

Pharmacists, under pressure from their pharmacy owners to prepare and dispense (sell) more drugs faster, hire inexperienced "technicians" who get a brief training period before they are turned loose to fill prescriptions. More pharmacy mistakes are made.

Doctors, needing to maximize their patient loads, as mentioned above, make more mistakes during appointments. Further, they jot down drug names on a prescription pad in a hurry -- leading to possible further mistakes.

Hospital personnel are in a hurry to make rounds, or dispense drugs. So, they don't may not take the time to wash their hands, thereby passing on more and more infections to patients.

4. Lack of Preventive Services

The lack of time also inhibits the former ability of doctors to help their patients stop smoking, or lose weight, or keep their blood pressure down (unless of course that can be done with a silver-bullet drug.)

Chronic diseases and conditions account for seven of 10 deaths among Americans each year, according to the CDC (Centers for Disease Control.) Cardiovascular problems, diabetes, arthritis, and chronic cancers affect 25 million Americans and cost us trillions of dollars each year. Preventive medicine could cut those figures dramatically.

Further, patients can't afford to see their doctors for things like flu shots or basic preventive care either because the doctor has no way to be reimbursed by insurance, or because a primary care doctor has no time in her day to see preventive care patients. Self-pay patients just don't spend the money on prevention.

5. Too Few Primary Care Providers

Because of the way reimbursements work, the primary care physician, who should be a triage level of care, or a gatekeeper to additional care, is becoming a rare breed. Estimates in 2008 say that the United States lacks 14,000 primary care doctors, and the problem is especially acute in rural areas.

Medical schools report that when it comes time for their students to commit to specialties for residencies, only 2% of students choose primary care areas to specialize in.

This dearth of primcary care providers means that it's difficult to get appointments for basic needs, and that those with specialized needs are simply skipping this step and going straight to specialists. If they choose the right type of specialist, they may get the help they need. But too many patients choose the wrong type of specialist. So, they may be misdiagnosed, undiagnosed, or must pay a second time to see a new, different type of specialist.

The Bottom Line -- Reasons the American Healthcare System Needs Reform

The bottom line to these problems and others is that Americans are not getting the effective healthcare they need, at the time they need it, at a cost that is affordable.

Thus the call for healthcare reform, in all aspects of what a good, reliable, effective healthcare system should be.

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