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

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.

• The Affordable Care Act (ACA) has made significant changes in the U.S. healthcare system. The provisions included in the ACA are intended to expand access to healthcare coverage, increase consumer protections, emphasize prevention and wellness, and promote evidence-based treatment and administrative efficiency in an attempt to curb rising healthcare costs.
• A significant provision of the ACA was creating health insurance marketplace exchanges in which individuals provided with a program such as Medicaid or Medicare can shop for health insurance. In addition, individuals with incomes between 100 percent and 400 percent of the federal poverty line would be eligible for advanced able premium tax credits to subsidize insurance costs.
• A national health service will be provided to low-income communities. The medical services are delivered via government-salaried physicians in hospitals and clinics that are publicly owned and operated—financed by the government through tax payments. In addition, private doctors have specific regulations on their medical practice; they collect their fees from the government.
• A multi-payer health insurance system provides comprehensive health insurance via “sickness funds,” used to pay physicians and hospitals uniform rates. This health insurance coverage eliminates the issue of paying the medical bills and higher costs of the uninsured, especially for emergency services.
• Developing consensus protocols that streamline medicine delivery and reduce variability can improve quality and lower costs in health care. However, more research on preventing medical errors from occurring is needed to address the problem.
• Through technology and innovation, find a qualified doctor that treats the condition properly. Some websites attempt to help to seek out the best doctor but lack updates necessary to keep up with constant changes. New technology will enable the users to quickly identify health experts specific to location and health condition, all within one interface. Online techniques and various resources will help people to get connected with different physicians and experts around the globe.
• The Affordable Care Act authorizes the state to negotiate the price of prescription drugs and bulk purchasing of prescription medications and durable medical equipment and supplies. This will help to lower the cost, and private insurers can continue to enter into private agreements between 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.