The US healthcare system has three main problems:
It’s too expensive: 18% of US GDP is spent on healthcare, compared to an average of 11% in other developed countries.
It’s not universal: 10% of Americans are uninsured.
It does a poor job managing chronic conditions: the lack of coordinated care delays appropriate care for patients with chronic conditions, creating worse health outcomes and driving up costs.
I have spilled much digital ink on how to address these problems. There are ways and they are doable. All it takes is political courage. Yeah, I know: ha ha.
Anyways, in this post I want to focus on one reason US healthcare sucks: over-reliance on specialists. Most developed countries use “gatekeepers” to coordinate medical care - usually primary care physicians or nurse practitioners. Patients have to go through gatekeepers to see specialists. This is a good thing, because specialists are:
Often unnecessary for the condition at hand.
Expensive, partly because they over-test and over-treat.
Poor at coordinating patient care.
Quote!
“A major weakness in typical outpatient and inpatient care delivery systems [in the US] is that primary care professionals, paramedics, emergency physicians, and hospitalists function in unintegrated silos that impede care coordination, inhibit communication, compromise quality, and raise costs. These and other modifiable barriers to access lead invariably to unmet health needs, delays in receiving appropriate care, and preventable hospitalizations.” Clarke et al, 2017
Fun Fact: Australia has fewer medical specialists and four times as many primary care providers per capita as the US. Yet their healthcare outcomes are as good or better! As in: high survival rates for breast cancer, colon cancer, and heart attacks following hospital admissions. And their healthcare spending is less than 10% of GDP.
Then again, Americans love their specialists – nothing soothes the soul so much as expensive displays of conspicuous compassion. We reap what we sow.
Next: How the Australians do it.
References:
Health Care Spending in the United States and Other High-Income Countries by Irene Papanicolas, Liana R. Woskie, and Ashish Jha/Commonwealth Fund March 13, 2018
Clarke, J. L., Bourn, S., Skoufalos, A., Beck, E. H., & Castillo, D. J. (2017). An Innovative Approach to Health Care Delivery for Patients with Chronic Conditions. Population health management, 20(1), 23-30.