The United States has by far the least efficient healthcare system of all the developed countries and healthcare costs continue to escalate without a coinciding increase in quality, despite having some of the most advanced healthcare tools and highly trained practitioners in the world. Here are 5 reasons why I think the US healthcare system underperforms the systems in other OECD countries and needs a massive revamp.
1. A dearth of primary care physicians :
Most developed economies have at least the foundation of a robust primary care system on top of which a sophisticated patient-centric care system can be built. But the US healthcare system is so badly managed that close to half of US citizens do not have a primary care provider. In US, there is only 0.5 primary care physicians for every thousand people whereas there are 1.25 primary care physicians for every thousand people in other OECD countries.
2.Poor coordination of care :
In US it is quite common for a patient to be attended by many medical specialists who go over the same procedure again and again for the same ailment with little coordination among them. Over 30% of medical tests that are ordered end up being repetitive because the provider failed to note that the test has already been run. On 70% of the occasion a patient meets a specialist in the US, the specialist would have no data about the patient from the primary care provider. Also over 60% of the time a referral goes unscheduled. This gross negligence of patient data has led to several medical induced errors claiming the lives of over 1,000 patients each day.
3. Lack of a system of preventive care :
Ideally we should be paying the provider for managing a population and not for a single episode of care. US care system is monetary incentive driven leading to unnecessary surgeries like an amputation that could have been averted, adverse drug reactions, etc. among other bad outcomes. The country needs a departure from such a system to a system that rewards preventive care.
4. Poor inclusion of US citizens into the healthcare system
In some US states nearly 27% of the people lack health insurance and hence lack access to healthcare services. Also it is appalling to note that 27% of the population can’t fill the prescription following a doctor’s Rx note. The figure is just 1% in Denmark, 3% in the UK and 5% in Canada. It is striking to observe the divide between US and rest of the developed world on healthcare inclusion of citizens.
5. Cumbersome process of accessing health records
US healthcare is system centric and not patient centric. About 10 years ago only 26% of patients could access their primary care document and that too after spending hours of time and little has changed to date. As a consequence, patients are forced to avail costly and less effective treatments at the point of ailment in a state of emergency as opposed to preventive care.
One of the primary reasons for the failure of the US healthcare system is that it lacks a foundation for data accountability – where do the data reside and who is accountable for the data have been grey areas. Additionally, troves of patient data remain under-utilized. I have spent the last decade or so on such a foundational build called Patient centered Medical Home (PCMH) which has the potential to transform US healthcare leveraging patient data. This concept of the medical home was integrated with Ed Wagner’s Chronic Disease Model and Thomas Bodenheimer and Kevin Grumbach’s advanced/proactive primary care model at the request of the Patient Centered Primary Care Collaborative into a set of principles known as the Joint principles of the Patient Centered Medical Home ( PMCH )
The PCMH is a set of team based health care delivery principles led by a physician who provides comprehensive and continuous medical care to patients with the goal of maximizing positive health outcomes. It is a framework for providing comprehensive primary care to people of all ages. It would serve as a home for all the patient data and where data is held accountable. It allows better access to health care, improves patient health and increases satisfaction of patients availing care. Joint principles that define a PCMH have been established through the cohesive efforts of the American Academy of Pediatrics (AAP), American Academy of Family Physicians (AAFP), American College of Physicians (ACP), and American Osteopathic Association (AOA).
Care coordination is an essential component of the PCMH. Care coordination requires additional resources such as health information technology, and appropriately trained staff to provide coordinated care through team-based models. Additionally, payment models that compensate PCMHs for their effort devoted to care coordination activities and patient-centered care management that fall outside the face-to-face patient encounter may help encourage coordination.
Listen to this webinar in which I and Tim Bushe, President & CEO – Envision Health, discuss in detail about PCMH. We also highlight findings from a recent payer study that helped to identify the five key reasons why today’s care management systems are failing to help health plans achieve their objectives.