Everyone has an opinion. Everyone has a personal story. Everyone is touched by healthcare issues at the deepest level, day in and day out. It may not be in your face at the moment, but we’ve all lived that moment when something quietly in the background becomes a prominent first-priority, drop-everything, in-your-face TODO.
But what *is* the problem with healthcare?
Is it the amount of information available?
No, you can get huge volumes of information free online for anything from the drugs you’re taking (RxList, drugs.com) to the conditions you have to the symptoms you’re experiencing (WebMD, Lumiata), and even support groups with communities of experts and caregivers who provide support and information. You can get opinions and input on how to treat symptoms and conditions, when to go to the hospital, how to get the support you need. But how do you know that the information is accurate and relevant and unbiased? How do you know that what you’re searching for and reading about is helpful to you?
Is it the cost?
According to the Center for Disease Control, between 2000 and 2010, total personal health care expenditures grew from $1.2 trillion to $2.2 trillion. During this period, the average annual growth in Medicare expenditures was 9%; for Medicaid it was 7%,for private insurance 6%, and for out-of-pocket spending 4%.
Is it the lack of access and use of preventive care services?
According to the Center for Disease Control, in 2011, 69% of children aged 19–35 months had completed a combined series of childhood vaccinations.
So most young children are getting access to physicians and vaccinations.
Is it the amount of emergency care services?
According to the Center for Disease Control, in 2011, 20% of persons reported at least one emergency department visit in the past year, and 7% reported two or more visits.
In 2009–2010, 81% of emergency department visits were discharged for follow-up care as needed, 16% ended with the patient being admitted to the hospital, 2% ended with the patient leaving without completing the visit, and less than 1% ended in the patient’s death.
In other words, most people are not going to emergency, and those that are are generally discharged for follow-up care rather than admitted.
Is it the lack of access to specialists?
According to the Center for Disease Control, in 2010, 19% of office visits made by children under age 18 were to specialty care physicians, as were 37% of visits by adults aged 18–44, more than one-half of visits by those aged 45–64, and nearly two-thirds of visits by those aged 65 and over.
The bottom line is that all age groups who make office visits are using specialists to some degree.
Is it the lack of insurance? Not really. The Affordable Care Act has helped make costs more manageable for many people, whether it’s ending pre-existing condition exclusions for children, keeping young adults covered, guaranteeing the right to appeal or ending lifetime limits on coverage.
Among adults aged 18–44, the percentage with private coverage declined from 70% in 2001 to 61% in 2011, while the percentage with Medicaid coverage doubled from 6% to 12%. The percentage of adults aged 18–44 who were uninsured increased from 22% to 25% during the same period. Similarly, between 2001 and 2011, the percentage of adults aged 45–64 with private coverage declined from 79% to 71%; the percentage with Medicaid coverage increased from 5% to 8%; and the percentage uninsured increased from 12% to 15%.
The bottom line is that although there are now fewer privately-insured adultsMedicare is taking up some of the slack, only 22% are uninsured.
Is it the shortage of doctors?
The Beckman Hospital Review does report that there will be a the nation will be short more than 90,000 total physicians by 2020 and 130,000 physicians by 2025.
But today, unless you you live in rural areas or are limited by your health coverage, it is not the shortage that is impacting our access to care.
Is it the use of and cost of prescription drugs?
According to the Center for Disease Control, in the United States, spending for prescription drugs was $259 billion in 2010, accounting for 12% of personal health care expenditure.
Between 1988–1994 and 2007–2010, the use of three or more prescription drugs in the past 30 days increased for all age groups of males and females. Some of the most commonly used prescription medications were asthma medicines and central nervous system stimulants for children and adolescents, antidepressants for middle-aged adults, and cholesterol-lowering and high blood pressure control drugs for older Americans.
However, between 2001 and 2011, the percentage of adults aged 18–64 who did notreceive needed prescription drugs in the past 12 months due to cost increased among those with private coverage and the uninsured and was stable among those with Medicaid. The range was 25-35% for uninsured, 11-14% for Medicare and 5-9% for those with private insurance.
In other words, even though the costs of prescription drugs and the amount of prescription drugs have increased, MOST people are managing to pay for these medications.
Is it the prevalence of chronic diseases and costs for their treatment?
According to the Center for Disease Control, in 2009–2011, 6% of children under age 18 had an asthma attack in the past year, and 5% had a food allergy. Ten percent of children under age 5 had three or more ear infections in the past year. Among school-age children aged 5–17, 10% had attention deficit hyperactivity disorder and 6% had serious emotional or behavioral difficulties.
In 2011, the percentage of noninstitutionalized adults who reported their health as fair or poor ranged from 7% of those aged 18–44 to 29% of those aged 75 and over.
Between 1988–1994 and 2007–2010, the prevalence of uncontrolled high blood pressure among adults aged 20 and over with hypertension decreased from 74% to 49%. Between 1988–1994 and 2007–2010, the percentage of adults aged 20 and over with a high serum total cholesterol level (defined as greater than or equal to 240 mg/dL) declined from 20% to 14%.
So although chronic and severe conditions impact people of all ages, most people are not impacted and the numbers are trending down.
But with all that is wrong with healthcare, there *are* ways we can make it work, if we all work together. It’s good for business, it’s good for patients and all stakeholders. Let’s lobby for solutions that are:
1. Providing information which is:
2. Informing stakeholders in a manner that is:
- Easily and readily available
3. Connecting stakeholders in order to:
- Inform all
- Document condition and treatment for future reference
- Facilitate collaboration
- Facilitate access to support and resources
- Coordinate on treatment
- Coordinate on coverage and payment of service
4. Providing comprehensive services:
- Recommendations for proactive health – diet and exercise
- Condition-based recommendations for proactive health
- Access to information, to consultation, to ongoing support
- Referrals to specialists as necessary
5. Supporting the pro-active health goals of patients:
- Goal-based, patient-identified, condition-based, diet and exercise recommendations
- Access to personal support network
- Access to community of others
6. Facilitating communication:
- Between patients, providers, physicians, care-takers
- Empowering all stakeholders with access to real-time, relevant, vetted information
- Facilitating communication throughout the diagnosis and treatment phases
- Providing ongoing support to facilitate proactive health choices
7. Providing access to service:
- Real-time access to vetted information
- Funneling the patients to the right providers and specialists
- Same day virtual consults
- Connections to specialists
8. Offering secure and compliant solutions:
- HIPAA Compliant
- Permission-based Access
9. Focusing on the care and well-being of patients/ Optimize the time providers connect to patients:
- Streamline coverage and payments and paperwork
- Partner with insurers, pharmacists and care-givers
- Providing the right information at the right time (see above)
- Facilitate communication and collaboration between a network of providers (see above)
- Focus on proactive health (see above)
- Provide access to comprehensive services (see above)
10. Offering cost-effective choices
- Optimizing insurance: both for In-network providers and Out-of-network providers
- Supplementing insurance with: a) Vetted, detailed, relevant, real-time information and b) Same day access to virtual consults
- Access to medications and treatments
- Access to proactive health support
We each have a role in solving the problem with healthcare:
- As employers, proactively supporting the health of your employees and their families makes good business sense:
- Having real-time access to the right time of care leads to fewer procedures requiring escalated treatment, fewer emergencies, fewer ongoing health problems, and ultimately lower cost of care.
- Better work-life integration leads to a happier, more productive, more loyal workforce.
- As patients and caregivers, you get information and peace of mind, so you feel empowered and productive during each health episode, and more proactive in between:
- Get vetted, real-time information on condition, treatments and symptoms.
- Receive timely advice from proven professionals on what to do about it.
- Connect with providers, insurers, caregivers and other stakeholders to focus on the health and well-being of the patient.
- As providers, you get to focus more on the ongoing care of your patients:
- Spend less time on process and paperwork, more time with patients.
- Leverage technology so that you can provide more information to a larger community and better personalized care for your individual patients.
- As insurers, efficiently providing access to providers, medications and services serves your customers well.
- Streamline which patients get what access to which networks of providers and services saves time and money and improves the service you provide to customers.
- Coordinate with networks of providers to optimize service, specialities and access.
- As policy-makers, focusing on policies that lead to individualized, real-time, cost-effective care of your constituents makes them happy, more likely to vote for you, and a more effective administration.
- Create policies that help all stakeholders focus on the health and well-being of all citizens.
- Create policies that ensure the secure and compliant transference of private medical information.
What are your thoughts on the problems with healthcare and fixes around that? What are healthcare challenges and stories you’d like to share?
Linda Holroyd is founder and CEO of FountainBlue, which coaches executives and advises start-ups, including tech-driven healthcare start-ups like HealthTap.