Why is Healthcare So Complicated? An Inside Look at the U.S. Healthcare System
Healthcare in the United States can be a labyrinthine and confusing maze, with myriad factors contributing to its complexity. This article delves into the intricacies of the healthcare system, explaining why it often feels so overwhelming and what factors underlie its current state.
Profit Motive in Health Insurance
When former U.S. President Richard Nixon stated, 'Medical care does not need to be non-profit,' he set the stage for the current business model in the healthcare industry. Unlike the initial intention of providing healthcare as a public good, many insurers operate with a profit motive at their core. Their primary goal is to maximize profits for their owners, which can lead to various issues, such as insurers interfering with patient care.
A Healthcare Success Story: Medicare and FEPBlue
Despite the prevailing complexity, there are success stories. I am a retired federal employee and benefit from Medicare and FEPBlue, a federal health insurance program that covers retirees. This coverage is a lifeline for me, ensuring financial security and maintaining my health. Thanks to the services provided by FEPBlue, I have been able to live a secure life and stay in good health.
Specialized Healthcare Facilities: A Case Study
My upcoming medical procedure is scheduled at a specialized surgery center in Tulsa, Oklahoma, once known as the ministry of a televangelist, Oral Roberts. Renegotiated and now owned by a group of local surgeons, this center operates as a world-class surgical facility. These surgeons are able to iterate with the insurance industry effectively, generating revenue for each procedure they perform. This business model allows doctors to own and profit from the center without breaking down the entire hospital infrastructure.
Beyond the Basics: A Multipronged Healthcare Experience
My healthcare journey is far from straightforward. I currently have 15 healthcare providers, including local pharmacies, physical therapists, and an integrated telemedicine service like Teledoc. The sheer volume of care I receive is staggering; I encounter medical professionals on average 100 times a year. Half of these visits are for physical therapy, which is a critical component of managing chronic conditions such as arthritis. In other instances, such as when I have bronchitis, I am directed to the emergency room for X-rays. Rarely counted are the visits with pharmacists who manage my medication regimen, which receive comprehensive reviews every 4-6 months.
My healthcare experience also relies on a dedicated nurse line, real-time monitoring of my glucose levels through a connected medical device, and regular check-ins with support members for certain medications. Additionally, I have access to four distinct patient portals that allow me to monitor my medical records and engage in online consultations.
Integrated Healthcare Systems: The Tulsa Model
A new development in the region is the EPIC system, a digital infrastructure that allows healthcare providers to share and access test results. This integration has significantly enhanced the coordination and efficiency of care across various specialists and clinics.
The Role of Technology in Modern Healthcare
Technology has played an increasingly prominent role in modernizing healthcare. Tools like telemedicine, electronic medical records, and portable monitoring devices have transformed how patients receive and manage care. For instance, my glucose meter automatically alerts a diabetes coach when my blood sugar levels become unstable, and the phone checks on me every four months to ensure my Hyqvia drug regimen is keeping me healthy.
Conclusion
The U.S. healthcare system is undoubtedly complex, with its strengths and weaknesses intertwined. Initiatives that enhance connectivity and reduce friction are crucial for improving the patient experience and ensuring that care remains accessible and affordable. The Tulsa region's embrace of digital integration is a promising step toward streamlining care and reducing the burden on individuals navigating the healthcare landscape.
Keywords
Healthcare Complexity, U.S. Healthcare, Healthcare Business Models