One of the primary problems existing in healthcare is the many barriers to access and delivery of care and treatment. Access to healthcare is centralized to a limited number of intermediary players in a way that is costly, non-transparent, and inefficient. It forces all of us to settle on whatever is given based on our locale and socioeconomic status, without having any real voice.
Access to care impacts patient’s physical, social, and mental well-being, as well as their overall quality of life. According to the Office of Disease Prevention and Health Promotion, people with a reliable source of care should have better health outcomes, fewer disparities, and lower costs. Yet according to the National Association of Community Health Centers, approximately 62 million individuals in the United States have limited or no access to primary care physicians as a result of shortages. This number is widely expected to increase over the next several years as our population grows older.
With an absence of convenient access to primary care physicians, patients turn to alternatives like emergency rooms, urgent care clinics, or choose to not seek care at all. All three options are more costly to the healthcare system than providing access to appropriate physicians.
In America, there is one medical doctor for every 434 people. It is important to note that physicians are not dispersed evenly throughout the country. Cuba, a country that has heavily emphasized medicine, has about six doctors for every 1,000 citizens. Conversely, in much of developing Africa, there is less than one healthcare practitioner (not necessarily a doctor) for every 1,000 people. India has fewer than one doctor for each 1,000 person.
Even in communities where healthcare exists, there are financial barriers to accessing care. Countries requiring but not providing health insurance or out-of-pocket payment put citizens at risk of delaying or forgoing treatment, hoping their ailments will go away. This increases costs overall as these same citizens are often treated in emergency rooms, and outcomes diminish because preventative treatment is all but forgotten.
High-quality affordable healthcare is important to help eliminate healthcare disparities and works to improve the overall health of the population, whereas more expensive healthcare increase the disparity between health of the affluent and the less well-off.
The cost of healthcare varies dramatically around the world. Many health systems are struggling to update aging infrastructure and legacy technologies with already limited capital resources.
As healthcare costs increase, affordability and insurance coverage remain problematic.
In the United States, deductible cost increases are far outpacing increases in costs covered by insurance.
Brazil’s private health insurance sector lost 2.5 million beneficiaries between 2014 and 2016 due to the country’s high unemployment rate. Added to that, companies in Brazil had to cut expenses, and changing their employees’ health insurance plan to a cheaper one was a popular option.
As mentioned previously, lack of access to care causes an increase in hospital and urgent care visits.
According to Centers for Disease Control and Prevention (CDC), 79.7 percent of non-admitted emergency room patient visits were due to lack of access to a healthcare provider. A recent study published in the Journal of American Medical Association estimated $734 billion (27 percent) of all healthcare spending was wasted on unnecessary services, inefficiency and inflated prices.
Similarly, according to Truven Health Analytics, 71 percent of emergency room visits with employer-sponsored insurance coverage are ambulatory sensitive, and could have been managed in an outpatient care center.
Moreover, as shown by the rise in medical tourism as a new industry, there is now a greater cost disparity in accessing healthcare than before. This new industry shows the cost of healthcare is such that patients are increasingly willing to travel overseas in order to take advantage of more competitive pricing for healthcare in other countries.
This makes it easier to connect patients in one geographic location to physicians in another, which can dramatically reduce costs, and create a freer and competitive market for high-quality medical services.
Today’s consumers want to take responsibility for managing their own health. Yet, most feel they don’t have the information and tools to do so. In other industries, customers can easily access comparisons of features, benefits, and costs to guide their purchasing decisions. In contrast, the healthcare industry presents a huge array of confusing choices, contact points, and service flows without any upfront pricing information.
Seventy-five percent of consumers consider their healthcare decisions as the most important and expensive decisions they make. Yet, the process of choosing and paying for medical services can be so daunting that patients often decline treatment simply to avoid the confusion and expense.
To make better decisions, healthcare consumers are increasingly expecting—and demanding—better information and more transparency from healthcare providers. They’re also asking for more of a partner relationship rather than a one-way dialog from medical provider to patient.
At the same time, as healthcare costs continue to rise, consumers are required to assume responsibility for a larger share of the costs of health plan premiums, co-pays, and out-of-pocket expenses, with no way to offset the cost.
Healthcare is a major expense worldwide and is estimated to account for $3 trillion in spending in the United States, and $6 trillion globally.
Combined healthcare spending in the five major world regions is expected to reach 8.7 trillion by 2020, up from $7 trillion in 2015. Global healthcare spending is projected to increase at an annual rate of 4.1 percent in 2017 through 2021, up from just 1.3 percent in 2012 through 2016. Aging and increasing populations, developing market expansion in advanced medical treatment, and rising labor costs drive spending growth. Still, global costs will vary wildly.
Per-person healthcare spending will span from $11,356 per person per year in the U.S. to just $53 in Pakistan in 2021.
Unfortunately, higher spending levels don’t always produce better health outcomes and value. For example, the United States continues to spend considerably more on healthcare (16.9 percent of GDP in 2016) than comparable countries, but it is in the lower half of the life expectancy rankings, according to the Organization of Economic Cooperation and Development (OECD). Historically, the United States healthcare payment system has been predominantly a fee-for- service model, and this has enabled a model of healthcare whereby a large driving force is obtaining profit. This has undermined the consumer-centric nature of the healthcare field.
The U.S. healthcare system is currently perceived as experiencing a growing crisis in terms of the level of access it provides, its costs, and the quality of care provided. Globally speaking, access to quality healthcare has reached crisis levels in many developing nations.
A Global Crisis
From a global perspective, most nations on the planet are too poor, and their healthcare system too disorganized, to provide any kind of efficient mass medical care. Clearly, such systems go against human ethics and create an even greater disparity—widening the gap between rich and poor. The rich can afford healthcare, while the poor stay sick or die. Even worse, in rural regions of Africa, India, China, and South America, hundreds of millions of people go their whole lives without ever seeing a doctor. They may scratch enough money or barter to obtain some medical advice, or only have access to a village healer using home remedies that may not be necessarily effective against disease.
Ironically, only the industrialized countries—perhaps 40 of the world’s 195 countries—have established healthcare systems, consolidated within each nation (Beveridge, Bismarck, National Health Insurance, and out-of-pocket ). Almost all nations have a variant or fusion of these models, but there are still issues in every system despite the policy-makers’ best efforts.
The Beveridge Model, for example, is not in the best interest of the people. It relies on very high taxes for basic healthcare, without providing access or incentives for preventative care, thus raising the bar of healthcare expenditure. The lack of individualization forces healthier people to be charged the same amount as the fatally sick. Canada is a highly cited example of a nation using a Beveridge Model.
The Bismarck Model, on the other hand, uses an insurance system which is usually financed jointly by employer and employees through payroll deduction. This system causes higher costs of healthcare and diminishes efficiency. Cost issues are often addressed by raising premiums instead of controlling prices. While the fixed price for procedures helps to control costs, the quality of healthcare from different providers varies. Most healthcare services are covered by a mandatory health insurance; beyond that, the patient co-pays for a portion of care at the time of treatment. This system, utilized in Germany, is flawed as it offers no alternative to compensate individuals for the rising costs implemented by the government, pharmaceutical, and private insurance companies.