How Would You Fix Healthcare? – Q & A

We asked our healthcare blog readers “What would you change about healthcare?”

And received many great responses, feel free to add your own in the comment section below:

Caitlin KellyI am a Canadian living in the U.S. The greatest problem in the U.S. healthcare system is totally unequal access to its benefits: students, the unemployed and those who cannot afford to buy insurance individually (it can easily cost $300 to 500 a month for a healthy individual) are left emotionally, physically and financially vulnerable to bankruptcy due to a medical crisis, while those who have it don’t have a clue what hell they face if they ever lose it.

Potential solutions? Remove all federal lawmakers from government-supplied healthcare and make them buy theirs on the open market so they see how brutal it is. Stop listening to the highly-paid fear-mongers who lobby for the HMOs, pharma companies and the AMA and really carefully examine a few government-run models that work, and work well. Try to uncouple greed and profit from the fundamental,, ethical, moral and human right to access good medical care, especially preventive care like mammograms. Why is it that you can only see a nutritionist ($300/hr not unusual) AFTER you are diabetic, covered therefore by insurance — and not as a preventive measure to safeguard your health in the first place?

Gregory Schulz

The number one issue with our healthcare system may be the need for broad access to affordable health insurance coverage with a disconnect from traditional employer paid health insurance coverage. Under a system whereby employees receive health insurance coverage as an employer paid benefit (all or in part) the actual economic consumer of healthcare becomes the employer – not the patient. Under this model, the patient consumes healthcare services based on their actual incremental out of pocket costs (e.g. copay, coinsurance). In many cases, the patient has no understanding of what the actual costs of their care might be. Therefore, the patient has no way to evaluate true cost vs quality of service. Thus, healthcare services will tend to be consumed on a basis that is relative to the minor out of pocket costs actually encountered.

Clearly, the incentives to the employer when purchasing health coverage for its employees will be significantly different from the incentives to the individual patient were they to purchase their own coverage. This misalignment of incentives is at the heart of the matter.

isabelle peper

We just reached 1.000.000 people (of 16M) suffering from Diabetes. My suggestion to our government is ensuring healthy food (fruits, vegetables and whole wheat foods) which now usually are very expensive become within financial reach of everyone. Right now, only the rich have access to healthy food.

stephen tuleja

Various interventions (in particular by the government) that distort the normal relationship between consumer demand and consumer cost. As with any product when the true cost is hidden from consumers, demand is artificially increased. There is no incentive for consumers to be efficient, so they demand endless services, and do not attempt to manage the cost. Solution: Increase consumer share of costs (e.g. percentage co-pays vs. fixed rate co-pays). If a patient has to pay 20% of the total cost of service, they will question; if they need it, and what it costs.

Mandi Bishop

1) Healthcare has become synonymous with health insurance, when the two should be mutually exclusive. Health CARE is the act of caring for our health, and we the patients are primarily responsible for that. I don’t insure my car for oil changes, gas fill-ups, washes and waxes, batteries, or windshield wipers – why should health insurance cover the cost of regular maintenance for humans?

2) Patient accountability for health is nominal, at best, amongst the majority of the country – as evidenced by obesity rate statistics. As a society, we continue to grow ever more obese, more sedentary, more drug-addled, and live longer due to extraordinary measures and technological advances. Yet, we don’t expect our healthcare costs to rise in accordance with our refusal to moderate our behavior.

3) All the other things that are typically listed as the biggest problems in healthcare today. 😉

How do we fix it? WE, the patients, have to start fixing OURSELVES. If we take responsibility for our own health, and stop treating insurance like a panacea for all care costs, it will radically reduce the spend. And then, we can continue to reduce that spend through the health IT advances already in-progress, but which will take a few years to demonstrate positive ROI.

Various interventions (in particular by the government) that distort the normal relationship between consumer demand and consumer cost. As with any product when the true cost is hidden from consumers, demand is artificially increased. There is no incentive for consumers to be efficient, so they demand endless services, and do not attempt to manage the cost. Solution: Increase consumer share of costs (e.g. percentage co-pays vs. fixed rate co-pays). If a patient has to pay 20% of the total cost of service, they will question; if they need it, and what it costs.

 Ken Larson

3 Big A’s

1. Access

2. Affordability

3. Asinine Regulations

Take a committee to Switzerland and make some astute observations. See Time Magazine article linked below. Here is an extract:

“Why should Americans listen to the Swiss? Because Switzerland’s healthcare model successfully delivers much of what the U.S is trying to achieve: universal coverage through mandatory private insurance.

Unlike most European countries, the Swiss don’t have socialized medicine, though the government regulates the insurance industry and defines what health services must be offered — a generous package that includes doctor’s visits, hospital stays, medications, physical therapy, physician-ordered rehabilitation, and in-home nursing care.

Under this law, which went into effect in 1996 to provide equal access to healthcare, everyone has to purchase a plan from one of 92 insurers. Employers don’t provide insurance, so people are free to shop around for coverage that fits their needs and not feel obligated to stay in a job solely for the health benefits it offers.”

Darcy Staley
In the US, the biggest problem of healthcare is the cost of it, from out-of-pocket patient costs, including insurance premiums, to malpractice coverage. The cost of medical insurance premiums alone has been out-pacing cost-of-living wage increases for more than a decade.

Another one of the biggest problems in healthcare today is the lack of “common ground” for communication. While HL7 went a long way toward improving the abilities for providers to communicate with insurers and Electronic Health Records (EHRs) have the ability to improve patient-to-provider and provider-to-patient care and communication, as well as provider-to-provider/pharmacist, etc., the proprietary software available prohibits communication among non-grouped facilities.

Yet another of the biggest problems in healthcare today is the unavailability of care in rural and more-remote locations. Unacceptable in the US, and yet an everyday-misfortune for too many.

Recommendations? I disagree that we shouldn’t have insurance for common ailments and health maintenance, for the simple fact that it’s truly unaffordable and has a direct bearing on our rights as Americans to “Life, Liberty and the Pursuit of Happiness”. Many studies back up the fact that preventative care (maintenance) builds a healthier population. That means fewer days off and higher productivity for our economy – a boon to everyone.

Possible cost solutions:
1) More competition of insurance companies to drive down costs and a common-sense, universal framework of coverage;

2) Mandatory transition for all healthcare providers, including hospitals, ambulatory care, pharmacies, medical suppliers, dentists, nursing home, etc. facilities to open-source, certified EHR systems;

3) Broadly-offered High-Deductible Health Plans for all employees, even part-time, with partnered pre-tax Flexible Spending Accounts or Healthcare Spending Accounts – along with incentives and assistance to use this system.

Possible communication solutions:
1) Mandatory, certified open-source EHR system implementation – see #2, above

2) Incentives for CTEs for providers and clinical staff to get up-to-date on how to use EHR solutions more effectively

3) Subsidized at-the-elbow training for healthcare facility staff to learn EHR software to improve efficiency and cost-savings

Possible inaccessibility to healthcare in rural and more-remote locations:
1) Improve adoption of telehealth opportunities and tools, including education and networking among professionals: a specialist in Massachusetts can feasibly treat a patient in a remote area of Montana, if the proper tools are in place for transferring information and facilitating communication

2) A portion of insurance company profits must go to staffing clinics and supporting clinicians of remote areas, including establishing reliable, high-speed internet access and EHR implementation.

I realize that a majority of my solution relies on the “Big Brother”-ish qualities of Electronic Health Records systems; however, despite legitimate concerns and foolish, avoidable security missteps, the efficiencies of communication and the ability of EHRs to promote a long-lasting, valid improvement in overall patient care and reduction in overall costs cannot be denied.

Jenelle Bourgeois

In my opinion, the biggest problem with health care today is universal (not unique to the USA). We focus on sick care, not health care. We are focused on treating symptoms of disease after they have manifested instead of promoting and encouraging the healthy lifestyle behaviors that prevent them. This change in paradigm needs to begin with our young.

In the USA, the exceptionally high cost of health care magnifies all issues – but there is absolutely no sustainable way of continuing to live (and die) the way we do with chronic, preventable diseases using up valuable and expensive limited resources. We have created a culture where being sick gets people rich.

David Shellhamer

Excellent question:
The United States spent $2,500,000,000,000, that’s two and a half trillion dollars on healthcare in 2009. This is without insuring approximately 40 million of us.

We MUST reduce healthcare spending and set limits for Medicare and Medi-Cal. There is no other option.

Now we want to know what you think

What are your thoughts on healthcare, the problems, and possible solutions (feel free to vent like I did above)

With over 25 years of experience in delivering the right products, partnerships, and services that lead to the success of healthcare technology companies; Rick Hammer serves as Chief Product Officer at ReferralMD

5 responses to “How Would You Fix Healthcare? – Q & A”

  1. The shortage of nursing assistants in long term care is preventing quality of care. a government program to recruit workers to that industry and to increase their wages would help immensely.

    • I agree Debra, lack of all types of health providers will be very problematic in the next 10 to 15 years. We are in for some serious trouble if we do not make it easier for people to get jobs in this field.

  2. Prevention is better than cure and Australia has a Industry in place with qualified people that are there for this purpose. The Medical association is so strong and has been protecting it’s source of income so well that it is now overloaded. Hospitals and Doctors are now complaining how overworked they are and how they need even more money.
    If the Government was genuine in wanting the nation to be healthier then an incentive to stay healthy should be looked at. If the Government would give a tax deduction on Fitness center memberships,this would be an enticement to a lot of people. With the obesity epidemic costing so much even a 10 -15% decrease in life style related diseases would save millions if not billions of dollars. The deduction should only come into effect if a person can show proof of regular attendance at a approved fitness over the 12 month period.
    This would encourage people to attend Fitness centers with qualified staff in attendance and counter act the discounting of membership to unsustainable levels. Extra employment in the industry would be created, quality of Fitness centers would be increased and it would be a win win situation. The Government suppliers no help or ineffectual help to this industry which has the potential to benefit Australia in such a positive way. It is would also be a fraction of the cost of supplying free or subsidized gastric banding.

    • It is combination of both our food habits (aka the Mcdonald effect) and lack of exercise that is going to kill the world. I do like the incentive for people that work out to get lower insurance rates. So tracking this activity would be somewhat burdensome but there are new technologies that can do this.

      Great ideas.

  3. From reader emails: David Bennett

    The cost of healthcare insurance with all that
    is happening and the escalation of cost will consume a large percentage of
    retirement for the majority of us, who don’t have a golden parachute package.

    At 50 years old an option should be offered to be able to take $10, 000 for
    every 10 years out of our 401K .

    Example – Take $40, 000 out at age 50 and be covered until 90 years old.

    This money should not be taxed as it is tax deferred in the 401K .

    The Insurance companies are being paid and we will not have to worry about this
    ever increasing cost for our retirement that at this rate will consume it all.

    If one dies prior to 90 years old , as in the example above – The Insurance
    company gets to keep the premium, If ones lives passed 90, Its up to the
    individual at that point in time to seek insurance.

    The way things are now – the money that is needed for coverage in retirement
    would far exceed this $40,000 that one would pay for now to have full healthcare

    This idea would also help employers to reinvest in their business , help grow
    the economy and provide employment opportunities in the US.

    Look forward to hearing your thoughts – Cheers

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