The U.S. Healthcare System is Broken: A National Perspective – Managed Healthcare Executive

© 2022 MJH Life Sciences and Managed Healthcare Executive. All rights reserved.




© 2022 MJH Life Sciences and Managed Healthcare Executive. All rights reserved.

The United States does not have a uniform health system and has no universal healthcare coverage. The health disadvantage of the U.S. relative to other high-income countries is health disparities in health services.
The United States does not have a uniform health system and has no universal healthcare coverage. The health disadvantage of the U.S. relative to other high-income countries is health disparities in health services.
Although the U.S. is renowned for its leadership in biomedical research and cutting-edge medical technology, its medical system faces significant issues such as preventable medical errors, poor amenable mortality rates, and lack of transparency in treatment. Another problem that Americans are facing is difficulty in finding a good doctor. High costs of care and lack of insurance coverage for low and middle-class families have led to social and economic discrimination in healthcare services.
Due to the shortage of nurses, physicians, and specialists in hospitals and health centers, among other rising challenges in public health care, Americans are unable to get the optimal quality of medical care they require.
The U.S. stands out from many countries in not offering universal health insurance coverage. Fifty million people, 16% of the U.S. population, lack insurance coverage. Medical expenditures such as pharmaceuticals and medical supplies have increasingly become unaffordable for marginalized communities. Therefore, paying medical bills and other medical costs have become high out-of-pocket expenses. Deprived communities continue to lack access to primary healthcare services and rely on emergency departments to treat chronic diseases and preventive care.
The Biggest Problems with the U.S. Health Care System
High Costs of Care
U.S. healthcare underperforms in most verticals. High cost is the primary reason that prevents Americans from accessing health care services. Americans with below-average incomes are much more affected, since visiting a physician when sick, getting a recommended test, or follow-up care has become unaffordable. These patients have acknowledged the difficulty in paying medical bills and other expenditures.
According to U.S. healthcare experts, the cost of new technologies and prescription drugs has risen. The availability of more expensive, state-of-the-art medical technologies and prescription drugs generate demand for more intense, costly services even if they are not necessarily cost-effective. The increased costs of medical services occur due to the rise of chronic diseases, including obesity. Nationally, chronic illnesses contribute huge proportions to healthcare costs, particularly during end-of-life care. For example, patients with chronic illness spend 32% of total Medicare spending, much of it going toward physician and hospital fees associated with repeated hospitalizations.
The National Academy of Sciences found that the U.S. has a higher rate of chronic illness and a lower overall life expectancy than other high-income nations. Therefore, medical experts focus more on preventative care to improve health and reduce the financial burdens associated with chronic disease.
High administrative costs are a contributing factor to the inflated costs of U.S. healthcare. The government outsources some of its administrative needs to private firms. The aim is to improve administrative efficiency and provide healthcare quality to the citizens.
Lack of Insurance Coverage
The majority of U.S. citizens have health insurance; however, the premiums are rising, and the quality of the insurance policies is falling. In addition, average annual premiums for family coverage have increased, outpacing inflation and workers' earnings.
The lack of health insurance coverage has severe consequences for the U.S. economy. The Center for American Progress estimated that the lack of health insurance in the U.S. costs society between $124 billion and $248 billion per year. In addition, shortened lifespans and the loss of productivity are observed due to the reduced health of the uninsured.
Health insurance coverage is uneven; minorities and deprived families lack insurance coverage. As a result, they face more health hardships than insured Americans. Moreover, the uninsured may not seek medical care due to high costs and avoid regular health screenings. Hence, they are also likely to access preventive health services as well.
The United States Census Bureau annually reports that around 27.5 million lower-income workers did not have health insurance. Lack of health insurance is associated with increased mortality, ranging from 30-90 thousand deaths per year. The number of people without health insurance coverage in the United States is one of the primary concerns raised by advocates of health care reforms and policymakers.
Lack of Transparency
Fraud and cover-ups are widespread in the U.S. healthcare system. For example, a significant problem is upcoding between providers and insurance providers. The providers “upcode” a procedure to get more money from insurance companies, but insurance charges higher premiums from employers. Hence, health consumers get stuck in the middle without any control over health outcomes and pricing.
Difficulty in finding physicians and specialists
With a lack of accessible doctor credentials and accomplishments, health consumers cannot easily find a good doctor. Instead, consumers rely on uninformed online reviews that can help with assessing traits like staff friendliness and wait times. But, these platforms do not evaluate a physician’s skill level in helping people with their health disorders.  A new AAMC study projects a shortfall of up to 139,000 physicians by 2033. According to the study, more physicians are reaching retirement age. More than 2 of 5 active physicians will be 65 or older within the next decade. Each doctor’s retirement plans affect the health system.
The growing concerns about specialists' burnout are also rising. The shortage of medical specialists has also affected America’s healthcare workforce, leading to a range of problems, from limited patient access to poorer outcomes. The increasing lack of physicians and medical experts over the last two decades has demonstrated that the medical system needs to increase the number of physicians to ensure safe and quality health care services for the people. Unfortunately, despite ongoing efforts by many healthcare leaders and academics to find long-term solutions, there doesn’t seem to be a solution in sight.
Health System Need to be Empowered
Broad changes are taking shape. For example, payers of health care are increasingly incorporating the concepts of social determinants of health into the way they think about compensating for healthcare services and providing incentives for health care service providers.
Thus, improving healthcare quality can be viewed on both a macro and a micro-level. It includes collecting data and analyzing patient outcomes, focusing on patient engagement, and collaborating with different organizations to provide access to health care.
Johonniuss Chemweno is founder & CEO of VIP StarNetwork, LLC, which is revolutionizing how industries offer healthcare benefits and increase healthcare access.

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